Abstract
BackgroundUndernutrition is common in older hospitalised patients, and routine screening is advocated. It is unclear whether screening tools such as the Birmingham Nutrition Risk (BNR) score and the Malnutrition Universal Screening Tool (MUST) can successfully predict outcome in this patient group.MethodsConsecutive admissions to Medicine for the Elderly assessment wards in Dundee were assessed between mid-October 2003 and mid-January 2004. Body Mass Index (BMI), MUST and BNR scores were prospectively collected. Time to death was obtained from the Scottish Death Register and compared across strata of risk.Results115 patients were analysed, mean age 82.1 years. 39/115 (34%) were male. 20 patients were identified as high risk by both methods of screening. A further 10 were categorised high risk only with the Birmingham classification and 12 only with MUST.80/115 (67%) patients had died at the time of accessing death records. MUST category significantly predicted death (log rank test, p = 0.022). Neither BMI (log rank p = 0.37) or Birmingham nutrition score (log rank p = 0.35) predicted death.ConclusionThe MUST score, but not the BNR, is able to predict increased mortality in older hospitalised patients.
Highlights
Undernutrition is common in older hospitalised patients, and routine screening is advocated
Body Mass Index (BMI), Malnutrition Universal Screening Tool (MUST) and Birmingham Nutrition Risk (BNR) scores were calculated by the admitting nurse, as part of the normal admissions procedure
By using mortality as an endpoint in this study we have shown that MUST is not an abstract tool but can be related to a real clinical outcome and has prognostic value when screening for nutritional risk in older patients
Summary
Undernutrition is common in older hospitalised patients, and routine screening is advocated. It is unclear whether screening tools such as the Birmingham Nutrition Risk (BNR) score and the Malnutrition Universal Screening Tool (MUST) can successfully predict outcome in this patient group. Undernutrition is known to be prevalent in hospitalized patients, with 40% of all patients admitted found to be undernourished[1]. Routine screening of nutritional state is recommended in all patients admitted to hospital to allow early intervention. Two commonly used tools are the Birmingham Nutrition Risk Score (BNR) and the newer Malnutrition Universal Screening Tool (MUST). The former, the Birmingham Nutrition Risk Score was developed in the mid 1990's at the Birmingham Heartlands Hospital[3]. Initial validation studies showed that the score correlated well with other previously described scores,
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