How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk

Abstract

BackgroundThe prevalence of malnutrition is high among the elderly population. Hospital admission is a window of opportunity for its detection. ObjectiveTo assess the concordance of different nutritional scales in hospitalized patients. MethodsProspective study in non-institutionalized patients over 65 years of age admitted to an internal medicine department. Five malnutrition screening surveys (MNA, MST, MUST, NRS-2000 and CONUT) and three nutritional risk screening surveys (SCREEN 3, 8 and 14) were compared. As gold standard we use the Global Malnutrition Leadership Initiative for Malnutrition (GLIM) definition of malnutrition. ResultsEighty-five patients (37% female, median age 83 years) were included. Forty-eight percent (95% CI 38–59%) of patients were classified as malnourished according to GLIM criteria. The SCREEN 3 scale was the most sensitive (93%; 95% CI 87–98) and MUST the most specific (91%; CI 85–99). The most effective scale for excluding suspected malnutrition was SCREEN 3 (LR− 0.17; 95% CI 0.05−0.53) and the best for confirming it was MST (LR+ 7.08; 95% CI 3.06–16.39). Concordance between the different scales was low or very low with kappa indices between 0.082 and 0.465. ConclusionsA comprehensive approach is needed to detect malnutrition in hospitalized patients. More sensitive scales are more useful in initial screening. Nutritional risk tools could be effective at this stage. In a second step, malnutrition should be confirmed according to established criteria such as GLIM.