Malnutrition screening tools : comparison against two validated nutrition assessment methods in older medical inpatients

Abstract

Objective: While several validated nutrition screening tools have been developed to “triage” inpatients for malnutrition diagnosis and intervention, there continues to be debate in the literature as to which tool/s clinicians should use in practice. This study compares the accuracy of seven validated screening tools in older medical inpatients against two validated nutrition assessment methods.

Research methods and procedures: Prospective cohort study of medical inpatients aged ≥65 years. Malnutrition screening was conducted using seven tools recommended in evidence-based guidelines. Nutritional status was assessed by Accredited Practicing Dietitian using Subjective Global Assessment (SGA) and Mini-Nutritional Assessment (MNA). Energy intake was observed on a single day during first week of hospitalisation.

Results: In this sample of 134 participants (80±8 years, 50% female), there was fair agreement between SGA and MNA (κ=0.53), with MNA identifying more “at risk” patients and SGA better identifying existing malnutrition. Most tools were accurate in identifying patients with malnutrition determined by SGA, particularly Malnutrition Screening Tool and Nutritional Risk Screening 2002. MNA Short Form was most accurate at identifying nutrition risk according to MNA. No tool accurately predicted patients with inadequate energy intake in hospital.

Conclusion: As all tools generally performed well, clinicians should consider choosing a screening tool which best aligns with their chosen nutrition assessment and is easiest to implement in practice. This study confirms the importance of re-screening and monitoring food intake to allow early identification and prevention of nutritional decline in patients with poor intake during hospitalisation.