{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:50:42Z","timestamp":1791838242640,"version":"4.3.4"},"reference-count":33,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T00:00:00Z","timestamp":1708646400000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2024,2,8]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Stress ulcers in patients with traumatic brain injury (TBI) and spinal cord injury (SCI) present significant morbidity and mortality risks. Despite the low reported stress ulcer rates, stress ulcer prophylaxis (SUP) is widely administered in neurocritical care. It was hypothesized that universal SUP administration may not be associated with reduced rates of complications across all neurocritical care patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective study encompassed neurocritical care patients aged \u226518 with moderate or severe TBI or SCI, admitted to the intensive care unit (ICU) between October 2020 and September 2021, across six level I trauma centers. Exclusions included patients with an ICU stay &lt;2\u2009days, prior SUP medication use, and pre-existing SUP diagnoses. The primary exposure was SUP, with the primary outcome being clinically significant gastrointestinal bleeds (CSGIBs). Secondary outcomes included pneumonia and in-hospital mortality. Patients were stratified by admission Glasgow Coma Scale (GCS) groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 407 patients, 83% received SUP, primarily H2 receptor antagonists (88%) and proton pump inhibitors (12%). Patients on SUP were significantly younger, had lower admission GCS scores, higher Injury Severity Scores, longer ICU stays, and higher rates of mechanical ventilation than non-SUP patients. Overall, CSGIBs were rare (1%) and not significantly different between the SUP and non-SUP groups (p=0.06). However, CSGIBs exclusively occurred in patients with GCS scores of 3\u20138, and SUP was associated with a significantly lower rate of CSGIBs in this subgroup (p=0.03). SUP was also linked to significantly higher pneumonia rates in both GCS 3\u20138 and GCS 9\u201312 patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study highlights the low incidence of CSGIBs in neurocritical trauma patients and suggests potential benefits of SUP, particularly for those with severe neurological impairment. Nevertheless, the increased risk of pneumonia associated with SUP in these patients warrants caution. Further research is crucial to refine SUP guidelines for neurocritical care patients and inform optimal strategies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Level III, retrospective.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2023-001285","type":"journal-article","created":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T11:40:11Z","timestamp":1708688411000},"page":"e001285","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Outcomes of patients with traumatic brain injury after stress ulcer prophylaxis: a retrospective multicenter study"],"prefix":"10.1136","volume":"9","author":[{"given":"Constance","family":"McGraw","sequence":"first","affiliation":[{"name":"Trauma Research, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigale","family":"Briscoe","sequence":"additional","affiliation":[{"name":"Trauma Services, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Trauma Services, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Carrick","sequence":"additional","affiliation":[{"name":"Trauma Services, Medical City Plano, Plano, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos H","family":"Palacio","sequence":"additional","affiliation":[{"name":"Trauma Services, South Texas Health System, McAllen Medical Center, McAllen, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Waswick","sequence":"additional","affiliation":[{"name":"Trauma Services, Wesley Medical Center, Wichita, Kansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"April","family":"Miller","sequence":"additional","affiliation":[{"name":"Trauma Services, Medical City Plano, Plano, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Trujillo","sequence":"additional","affiliation":[{"name":"Trauma Services, Penrose Hospital, Colorado Springs, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3685-314X","authenticated-orcid":false,"given":"David","family":"Bar-Or","sequence":"additional","affiliation":[{"name":"Trauma Research, Swedish Medical Center, Englewood, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,23]]},"reference":[{"key":"2025081711202687000_9.1.e001285.1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/S1008-1275(08)60024-3","article-title":"Cushing\u2019s ulcer in traumatic brain injury","volume":"11","author":"Biteghe-bi-Nzeng","year":"2008","journal-title":"Chinese Journal of Traumatology (English Edition)"},{"key":"2025081711202687000_9.1.e001285.2","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aem139"},{"key":"2025081711202687000_9.1.e001285.3","doi-asserted-by":"crossref","first-page":"87","DOI":"10.4103\/1793-5482.154976","article-title":"Cushing\u2019s ulcer: further reflections","volume":"10","author":"Kemp","year":"2015","journal-title":"Asian J Neurosurg"},{"key":"2025081711202687000_9.1.e001285.4","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1080\/08998280.2009.11928562","article-title":"Stress ulcer prophylaxis in the intensive care unit","volume":"22","author":"Mohebbi","year":"2009","journal-title":"Baylor University Medical Center Proceedings"},{"key":"2025081711202687000_9.1.e001285.5","doi-asserted-by":"crossref","DOI":"10.4103\/2277-9175.125789","article-title":"The comparison between proton pump inhibitors and Sucralfate in incidence of ventilator associated pneumonia in critically ill patients","volume":"3","author":"Khorvash","year":"2014","journal-title":"Adv Biomed Res"},{"key":"2025081711202687000_9.1.e001285.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2002.06037.x"},{"key":"2025081711202687000_9.1.e001285.7","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1993.01420140062010"},{"key":"2025081711202687000_9.1.e001285.8","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp060393"},{"key":"2025081711202687000_9.1.e001285.9","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0b013e32832978e0"},{"key":"2025081711202687000_9.1.e001285.10","doi-asserted-by":"crossref","unstructured":"Li F , Liu H , Zhang L , Huang X , Liu Y , Li B , Xu C , Lyu J , Yin H . 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