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Hye-Suk Kim1, 2
, Seonheui Lee1, 3, Hyesook Kim4, Oran Kwon1, 4
, Seonheui Lee1, 3, Hyesook Kim4, Oran Kwon1, 4
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.
Figures and Tables
Table 1
Patient characteristics based on an anthropometric and laboratory data at hospital admission (n = 686)
Table 2
Diagnosis department by CKUNRS at hospital admission (n = 686)
Values are presented as number of subjects (%).
p value is from fisher's exact test.
CKUNRS: Catholic Kwandong University Nutritional Risk Screening, Low risk (0 ~ 4), Moderate risk (5 ~ 7), High risk (more than 8)
Other diseases: Diseases of the genitourinary system except N 10 ~ 29, Diseases of the circulatory system except I 00 ~ 52
Table 3
Patient characteristics by CKUNRS and PG-SGA at hospital admission (n = 686)
Values are presented as mean ± standard deviation.
p value is from χ2 test for categorical variables and ANOVA test for continuous variables.
Different superscript letter indicates the comparison with significant differences between the groups by CKUNRS or PG-SGA as determined by Duncan's multiple range test (p < 0.05).
CKUNRS: Catholic Kwandong University Nutritional Risk Screening, Low risk (0 ~ 4), Moderate risk (5 ~ 7), High risk (more than 8)
PG-SGA: Patient Generated-Subjective Global Assessment, Stage A (0 ~ 3), Stage B (4 ~ 8), Stage C (more than 8)
BMI: body mass index
Table 4
Correlation of anthropometrics and laboratory data and nutritional risk by CKUNRS and PG-SGA at hospital admission
Table 5
Comparison of nutritional risk by CKUNRS and PG-SGA at hospital admission
Values are presented as number of subjects (%).
p value is from fisher's exact test.
CKUNRS: Catholic Kwandong University Nutritional Risk Screening, Low risk (0 ~ 4), Moderate risk (5 ~ 7), High risk (more than 8)
PG-SGA: Patient Generated-Subjective Global Assessment, Stage A (0 ~ 3), Stage B (4 ~ 8), Stage C (more than 8)
Table 6
Statistical comparison of CKUNRS and PG-SGA at hospital admission
Values are presented as number of subjects (%).
CI, Confidence interval; k statistic, percent of agreement
CKUNRS: Catholic Kwandong University Nutritional Risk Screening, Low risk (0 ~ 4), Moderate risk (5 ~ 7), High risk (more than 8)
PG-SGA: Patient Generated-Subjective Global Assessment, Stage A (0 ~ 3), Stage B (4 ~ 8), Stage C (more than 8)
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