(1555) Stress Ulcer Prophylaxis in Neurocritical Care Outcomes Following Trauma: A Multicenter Study

Introduction: Stress ulcers are a significant concern in traumatic brain injury (TBI) and spinal cord injury (SCI) patients, leading to heightened morbidity and mortality risks. Despite low reported stress ulcer rates, stress ulcer prophylaxis (SUP) remains widely used, with uncertain risks and benefits. This study aimed to assess the impact of SUP on neurocritical care outcomes in trauma centers.

Methods: A retrospective analysis included ICU-admitted trauma patients aged ≥18 with moderate or severe TBI or SCI in six Level I trauma centers (October 2020 - September 2021). Patients with ICU LOS < 2 days were excluded. Univariate analysis compared SUP and non-SUP patients. Primary exposure: SUP; primary outcome: clinically significant gastrointestinal bleeds (CSGBs); secondary outcomes: pneumonia and in-hospital mortality. Patients were stratified by admission Glasgow Coma Scale (GCS) groups.

Results: Among 407 patients, 83% received SUP, mainly H2 receptor antagonists (88%) and proton pump inhibitors (12%). The SUP patients, compared to non-SUP patients, were significantly younger (44.5 vs. 53, p=0.01), had a lower median admission GCS (3 vs. 7, p< 0.001), higher injury severity scores (26 vs. 22, p=0.004), longer ICU stays (8 vs. 3 days, p=0.001), and higher ventilation rates (89% vs. 63%, p< 0.001). Six patients had CSGIBs, limited to GCS 3-8, with no differences between groups (1% SUP vs. 4% non-SUP, p=0.07). The SUP group showed significantly higher pneumonia rates (21% vs. 1%, p< 0.001), but no in-hospital mortality differences compared to the non-SUP patients. GCS 3-8 patients on SUP had lower CSGIB rates (1% vs. 7%, p=0.03) but higher pneumonia rates (23% vs. 2%, p=0.002). GCS 9-12 patients had more pneumonia on SUP (15% vs. 0%, p=0.03), with no other differences found.

Conclusions: Our study indicates that SUP may benefit higher severity head injury patients, with a lower rate of CSGBs observed among GCS 3-8 patients. However, the higher pneumonia rates in the SUP group warrant caution. Further research is needed to optimize SUP strategies and assess its risk-benefit profile in neurocritical care.