Development and Evaluation of a Nutritional Risk Screening Tool (NRST) for Hospitalized Patients

Jin Soon Han; Song Mi Lee; Hye Kyung Chung; Hong Seok Ahn; Seung Min Lee

doi:10.4163/kjn.2009.42.2.119

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Han, Lee, Chung, Ahn, and Lee: Development and Evaluation of a Nutritional Risk Screening Tool (NRST) for Hospitalized Patients

Original Article

Korean Journal of Nutrition

Korean Journal of Nutrition 2009; 42(2): 119-127.

Published online: 31 March 2009

DOI: https://doi.org/10.4163/kjn.2009.42.2.119

Development and Evaluation of a Nutritional Risk Screening Tool (NRST) for Hospitalized Patients

Jin Soon Han^*, Song Mi Lee^**, Hye Kyung Chung^**, Hong Seok Ahn^*, Seung Min Lee^*

^*Department of Food and Nutrition, Sungshin Women's University, Seoul 136-742, Korea.

^**Nutrition Team, Gangnam Severance Hospital, Seoul 135-720, Korea.

To whom correspondence should be addressed. (sullenelee@gmail.com)

Received 28 January 2009 Revised 20 February 2009 Accepted 13 March 2009

Abstract

Malnutrition of hospitalized patients can adversely affect clinical outcomes and cost. Several nutritional screening tools have been developed to identify patients with malnutrition risk. However, many of those possess practical pitfalls of requiring much time and labor to administer and may not be highly applicable to a Korean population. This study sought to develop and evaluate a Nutrition Risk Screening Tool (NRST) which is simple and quick to administer and widely applicable to Korean hospitalized patients with various diseases. The study was also designed to generate a screening tool predictable of various clinical outcomes and to validate it against the Nutritional Risk Screening 2002 (NRS 2002). Electronic medical records of 424 patients hospitalized at a general hospital in Seoul during a 14-month period were abstracted for anthropometric, medical, biochemical, and clinical outcome variables. The study employed a 4-step process consisting of selecting NRST components, searching a scoring scheme, validating against a reference tool, and confirming clinical outcome predictability. NRST components were selected by stepwise multiple regression analysis of each clinical outcome (i.e., hospitalization period, complication, disease progress, and death) on several readily available patient characteristics. Age and serum levels of albumin, hematocrit (Hct), and total lymphocyte count (TLC) remained in the last model for any of 4 dependent variables were decided as NRST components. Odds ratios of malnutrition risk based on NRS 2002 according to levels of the selected components were utilized to frame a scoring scheme of NRST. A NRST score higher than 3.5 was set as a cut-off score for malnutrition risk based on sensitivity and specificity levels against NRS 2002. Lastly differences in clinical outcomes by patients' NRST results were examined. The results showed that the NRST can significantly predict the in-hospital clinical outcomes. It is concluded that the NRST can be useful to simply and quickly screen patients at high-nutritional risk in relation to prospective clinical outcomes.

Keywords: nutrition screening tool, hospitalized patients, nutritional risk, clinical outcome

Figures and Tables

Fig. 1

NRS 2002.

Fig. 2

Flow chart of study design.

Table 1

Basic characteristics of subjects (n = 424)

Table 2

Stepwise multiple regression analysis of clinical outcomes on readily available patients' characteristics (n = 424)

^**: p < 0.01, ^***: p < 0.001

Table 3

Result of logistic regression of NRS 2002 on selected NRST components (n = 142)

Table 4

Nutrition risk screening tool

Table 5

Sensitivity and specificity according to NRST score against NRS 2002 (n = 142)

Table 6

Association between clinical outcomes and NRST result (n = 142)

^*: p < 0.05, ^**: p < 0.01

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