Application and Efficacy Evaluation of Nutritional Screening Tool

Yun, Jung Suk; Shin, Jeong Eun; Kang, Bong Jin; Yang, Young Hee; Ka, So Young; Choi, Hye Eun; Ahn, Myung Ja; Han, Sun Hee; Namgung, Hwan; Lee, Doo Sun

Abstract

PURPOSE: Malnutrition has been frequently reported for patients on their admission to the hospital and it has been associated with an increase in morbidity, mortality and the length of the hospital stay. Although a number of screening tools have been developed to identify those patients at risk for malnutrition, there is no 'gold standard' for defining malnutrition and the malnourished patients remain largely unrecognized. The aim of this study is to evaluate the efficacy of a nutritional screening tool for use in Dankook University Hospital.
METHODS
Nutritional evaluation was performed for 53 patients who were admitted to the department of surgery and internal medicine between October and December 2004. The screening tool was completed by the ward nurse and the nutritional support team nurse on the same patients within 24 hours of admission. The nutritional support team nurse performed the full assessment. The screening sheet included 4 questions regarding body mass index, recent unintentional weight loss, food intake and disease severity. Each answer was scored and a total of 5 was tested as the criterion for malnutrition. The full assessment included current body weight, recent weight loss, triceps skinfold thickness, mid- arm muscle circumference, serum albumin and total lymphocyte count. Malnutrition was defined by 3 or more values below the reference values. The reliability of the screening tool was assessed using kappa statdtatistic. Sensitivity, specificity and accuracy were calculated to evaluate the validity of the screening tool. The receiver operating characteristic (ROC) curve was drawn to choose a cutoff value that maximizes sensitivity and specificity.
RESULTS
The level of agreement between the ward nurse and the NST nurse was good for BMI and food intake and moderate for weight loss and disease severity. The full assessment identified 7 patients (13.2%) as malnourished. The screening sheet had a sensitivity of 86% and a specificity of 80%. According to the ROC curve, a score of 5 points provided the best validity.
CONCLUSION
The nutritional screening tool is reliable when completed by different observers and it is valid for nutritional assessment.