Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
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Validation of initial nutrition screening tool for hospitalized patients

입원 환자용 초기 영양검색도구의 타당도 검증

  • Kim, Hye-Suk (Department of Clinical Nutrition Science, The Graduate School of Clinical Health Sciences, Ewha Womans University) ;
  • Lee, Seonheui (Department of Clinical Nutrition Science, The Graduate School of Clinical Health Sciences, Ewha Womans University) ;
  • Kim, Hyesook (Department of Nutritional Science and Food Management, Ewha Womans University) ;
  • Kwon, Oran (Department of Clinical Nutrition Science, The Graduate School of Clinical Health Sciences, Ewha Womans University)
  • 김혜숙 (이화여자대학교 임상보건과학대학원 임상영양학전공) ;
  • 이선희 (이화여자대학교 임상보건과학대학원 임상영양학전공) ;
  • 김혜숙 (이화여자대학교 식품영양학과) ;
  • 권오란 (이화여자대학교 임상보건과학대학원 임상영양학전공)
  • Received : 2019.04.05
  • Accepted : 2019.06.20
  • Published : 2019.08.31
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Abstract

Purpose: Poor nutrition in hospitalized patients is closely linked to an increased risk of infection, which can result in complications affecting mortality, as well as increased length of hospital stay and hospital costs. Therefore, adequate nutritional support is essential to manage the nutritional risk status of patients. Nutritional support needs to be preceded by nutrition screening, in which accuracy is crucial, particularly for the initial screening. To perform initial nutrition screening of hospitalized patients, we used the Catholic Kwandong University (CKU) Nutritional Risk Screening (CKUNRS) tool, originally developed at CKU Hospital. To validate CKUNRS against the Patient-Generated Subjective Global Assessment (PG-SGA) tool, which is considered the gold standard for nutritional risk screening, results from both tools were compared. Methods: Nutritional status was evaluated in 686 adult patients admitted to CKU Hospital from May 1 to July 31, 2018 using both CKUNRS and PG-SGA. Collected data were analyzed, and the results compared, to validate CKUNRS as a nutrition screening tool. Results: The comparison of CKUNRS and PG-SGA revealed that the prevalence of nutritional risk on admission was 15.6% (n = 107) with CKUNRS and 44.6% (n = 306) with PG-SGA. The sensitivity and specificity of CKUNRS to evaluate nutritional risk status were 98.7% (96.8 ~ 99.5) and 33.3% (28.1 ~ 39.0), respectively. Thus, the sensitivity was higher, but the specificity lower compared with PG-SGA. Cohen's kappa coefficient was 0.34, indicating valid agreement between the two tools. Conclusion: This study found concordance between CKUNRS and PG-SGA. However, the prevalence of nutritional risk in hospitalized patients was higher when determined by CKUNRS, compared with that by PG-SGA. Accordingly, CKUNRS needs further modification and improvement in terms of screening criteria to promote more effective nutritional support for patients who have been admitted for inpatient care.

본 연구는 입원환자의 초기영양평가를 위해 개발된 영양검색도구의 타당성을 평가하고자 입원 후 24시간이내 동일한대상자에게 PG-SGA와 개별면담을 시행 후 그 결과를 비교 평가하였다. CKUNRS와 PG-SGAS 두 그룹 모두 나이는 고위험군이 평균 연령보다 높았고, BMI, 혈청 알부민과 헤모글로빈은 영양불량이 심할수록 유의적으로 낮게 나타났다. CKUNRS와 PG-SGA를 비교 분석한 영양 평가결과 전체 686명 중 영양불량 위험 환자는 각각 107명(15.6%)과 380명 (44.6%)으로 조사되었다. 민감도와 특이도는 각각 98.7% (96.8 ~ 99.5)와 33.3% (28.1 ~ 39.0)로 나타났으며, 두 도구 간 유사성 kappa 지수는 0.34로 CKUNRS는 PG-SGA를 기준으로 어느 정도 타당한 검색도구로 검증되었다. 결론적으로, CKUNRS를 PG-SGA와 같은 공인된 영양검색도구와 비교한 결과 민감도와 유사성 면에서는 어느 정도 타당한 수준의 영양검색도구인 것으로 판정되었으나, 특이도가 높지 않은 부분에 대해서는 추가적인 고려가 필요할 것으로 보인다. 초기입원 영양평가로 효과적인 영양검색도구를 위하여 재원기간, 합병증 유무, 사망률, 환자의 질병 예후와 관련된 유용성은 검증되지 않아 이에 관련하여 추가적 연구가 필요하다고 사료된다. 그리고 보다 정확한 영양불량 환자의 검색을 위해서는 간호사의 입원환자 초기 평가 및 재평가 부분에서 누락 가능성이 있는 체중변화, 소화기계장애, 식욕상태, 저작곤란, 연하곤란 등의 정확한 기록을 할 수 있도록 간호사정 기록자의 지속적인 교육이 필요할 것으로 보이며, 효과적인 초기 영양관리를 위해서는 향후 CKUNRS의 영양검색 기준에 대한 수정보완이 필요하다고 사료된다.

Keywords

References

  1. Rha M. Effects of clinical outcome of hospitalized patients by means of nutritional status [dissertation]. Seoul: Seoul National University; 2006.
  2. Korean Dietetic Association. Manual of medical nutrition therapy. 3rd edition. Seoul: Korean Dietetic Association; 2008.
  3. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003; 22(3): 235-239. https://doi.org/10.1016/S0261-5614(02)00215-7
  4. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27(1): 5-15. https://doi.org/10.1016/j.clnu.2007.10.007
  5. Allison SP. Malnutrition, disease, and outcome. Nutrition 2000;16(7-8): 590-593. https://doi.org/10.1016/S0899-9007(00)00368-3
  6. Sullivan DH, Sun S, Walls RC. Protein-energy undernutrition among elderly hospitalized patients: a prospective study. JAMA 1999; 281(21): 2013-2019. https://doi.org/10.1001/jama.281.21.2013
  7. Heymsfield SB, Bethel RA, Ansley JD, Gibbs DM, Felner JM, Nutter DO. Cardiac abnormalities in cachectic patients before and during nutritional repletion. Am Heart J 1978; 95(5): 584-594. https://doi.org/10.1016/0002-8703(78)90300-9
  8. Pichard C, Kyle UG, Morabia A, Perrier A, Vermeulen B, Unger P. Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay. Am J Clin Nutr 2004; 79(4): 613-618. https://doi.org/10.1093/ajcn/79.4.613
  9. Han JS, Lee SM, Chung HK, Ahn HS, Lee SM. Development and evaluation of a nutritional risk screening tool (NRST) for hospitalized patients. Korean J Nutr 2009; 42(2): 119-127. https://doi.org/10.4163/kjn.2009.42.2.119
  10. Reilly JJ Jr, Hull SF, Albert N, Waller A, Bringardener S. Economic impact of malnutrition: a model system for hospitalized patients. JPEN J Parenter Enteral Nutr 1988; 12(4): 371-376. https://doi.org/10.1177/0148607188012004371
  11. Windsor JA, Hill GL. Risk factors for postoperative pneumonia. The importance of protein depletion. Ann Surg 1988; 208(2): 209-214. https://doi.org/10.1097/00000658-198808000-00013
  12. Dougherty D, Bankhead R, Kushner R, Mirtallo J, Winkler M. Nutrition care given new importance in JCAHO standards. Nutr Clin Pract 1995; 10(1): 26-31. https://doi.org/10.1177/011542659501000126
  13. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 2002; 56(8): 779-785. https://doi.org/10.1038/sj.ejcn.1601412
  14. Kim SY, Yeom HS, Park YM, Chung SH, Shin AR, Han HS, et al. Comparison of tools for nutritional risk screening at hospital admission. J Korean Soc Parenter Enter Nutr 2009; 2(1): 6-12.
  15. Ministry of Health and Welfare. 2014 Guidelines for hospital evaluation program. Sejong: Ministry of Health and Welfare; 2014.
  16. Kim YH, Seo AR, Kim MK, Lee YM. Relationship of nutritional status at the time of admission to length of hospital stay (LOS) and mortality: a prospective study based on computerized nutrition screening. J Korean Diet Assoc 1999; 5(1): 48-53.
  17. Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 1999; 15(6): 458-464. https://doi.org/10.1016/S0899-9007(99)00084-2
  18. Kyle UG, Kossovsky MP, Karsegard VL, Pichard C. Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clin Nutr 2006; 25(3): 409-417. https://doi.org/10.1016/j.clnu.2005.11.001
  19. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22(3): 321-336. https://doi.org/10.1016/S0261-5614(02)00214-5
  20. Ockenga J, Freudenreich M, Zakonsky R, Norman K, Pirlich M, Lochs H. Nutritional assessment and management in hospitalised patients: implication for DRG-based reimbursement and health care quality. Clin Nutr 2005; 24(6): 913-919. https://doi.org/10.1016/j.clnu.2005.05.019
  21. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature--What does it tell us? J Nutr Health Aging 2006; 10(6): 466-485.
  22. Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MA. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr 2005; 82(5): 1082-1089. https://doi.org/10.1093/ajcn/82.5.1082
  23. Ruiz-Lopez MD, Artacho R, Oliva P, Moreno-Torres R, Bolanos J, de Teresa C, et al. Nutritional risk in institutionalized older women determined by the Mini Nutritional Assessment test: what are the main factors? Nutrition 2003; 19(9): 767-771. https://doi.org/10.1016/S0899-9007(03)00125-4
  24. Persson C, Sjoden PO, Glimelius B. The Swedish version of the patient-generated subjective global assessment of nutritional status: gastrointestinal vs urological cancers. Clin Nutr 1999; 18(2): 71-77. https://doi.org/10.1016/S0261-5614(99)80054-5
  25. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33(1): 159-174. https://doi.org/10.2307/2529310
  26. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22(4): 415-421. https://doi.org/10.1016/S0261-5614(03)00098-0
  27. Almeida AI, Correia M, Camilo M, Ravasco P. Length of stay in surgical patients: nutritional predictive parameters revisited. Br J Nutr 2013; 109(2): 322-328. https://doi.org/10.1017/S0007114512001134
  28. Lee JS, Cho MR, Lee GJ. Validation of the developed nutritional screening tool for hospital patients. Korean J Nutr 2010; 43(2): 189-196. https://doi.org/10.4163/kjn.2010.43.2.189
  29. Guerra RS, Fonseca I, Sousa AS, Jesus A, Pichel F, Amaral TF. ESPEN diagnostic criteria for malnutrition - A validation study in hospitalized patients. Clin Nutr 2017; 36(5): 1326-1332. https://doi.org/10.1016/j.clnu.2016.08.022
  30. Agarwal E, Ferguson M, Banks M, Bauer J, Capra S, Isenring E. Nutritional status and dietary intake of acute care patients: results from the Nutrition Care Day Survey 2010. Clin Nutr 2012; 31(1): 41-47. https://doi.org/10.1016/j.clnu.2011.08.002
  31. Almeida AI, Correia M, Camilo M, Ravasco P. Nutritional risk screening in surgery: valid, feasible, easy! Clin Nutr 2012; 31(2): 206-211. https://doi.org/10.1016/j.clnu.2011.10.003
  32. Pirlich M, Schutz T, Norman K, Gastell S, Lubke HJ, Bischoff SC, et al. The German hospital malnutrition study. Clin Nutr 2006; 25(4): 563-572. https://doi.org/10.1016/j.clnu.2006.03.005
  33. Yun OH, Lee G, Park YJ. Development of a simplified malnutrition screening tool for hospitalized patients and evaluation of its inter-methods reliability. J Nutr Health 2014; 47(2): 124-133. https://doi.org/10.4163/jnh.2014.47.2.124
  34. World Health Organization. The world health report 2002: reducing risks, promoting healthy life. Geneva: World Health Organization; 2002.
  35. Lee YE, Park JE, Hwang JY, Kim WY. Comparison of health risks according to the obesity types based upon BMI and waist circumference in Korean adults: the 1998-2005 Korean National Health and Nutrition Examination Surveys. Korean J Nutr 2009; 42(7): 631-638. https://doi.org/10.4163/kjn.2009.42.7.631
  36. Sim KW, Lee SH, Lee HS. The relationship between body mass index and morbidity in Korea. J Korean Soc Study Obes 2001; 10(2): 147-155.
  37. World Health Organization Western Pacific Region; International Association for the Study of Obesity; International Obesity TaskForce. The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne: Health Communications Australia; 2000.
  38. van Venrooij LMW, de Vos R, Borgmeijer-Hoelen AJ, Kruizenga HM, Jonkers-Schuitema CF, de Mol BAMJ. Quick-and-easy nutritional screening tools to detect disease-related undernutrition in hospital in- and outpatient settings: a systematic review of sensitivity and specificity. E Spen Eur E J Clin Nutr Metab 2007; 2(2): 21-37. https://doi.org/10.1016/j.eclnm.2007.03.001

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