Is There a Better Tool to Identify Patients at Nutritional Risk in Emergency Units?

Abstract

ObjectivesTo compare nutritional risk in patients admitted to the emergency unit, by the instruments Nutritional Risk Screening-2002 (NRS), Nutritional Risk Emergency-2017 (NRE), and Malnutrition Universal Screening Tool (MUST). MethodsCross-sectional study, carried out in the emergency unit of a public hospital in Brazil. The sample consisted of adult patients (≥ 19 years old), of both sexes. Nutritional risk was assessed within 24 hours after hospital admission. Patients with a score ≥ 3 by the NRS, ≥ 1.5 by the NRE and, ≥ 2 by the MUST were classified with risk. The NRE is a tool made up of 6 subjective questions, while the NRS and MUST use objective measures of analysis. The data were expressed in absolute (n) and relative (%) frequencies and the analysis of agreement between the instruments was performed using the Kappa test. Results432 patients were assessed (age 57.31 ± 15.6 years and 54.4% women). The prevalence of nutritional risk by NRS, NRE, and MUST tools was 36%, 45%, and 46%, respectively. There was moderate agreement between the tools, NRS and NRE (Kappa = 0.599 p < 0.01), MUST and NRE (Kappa = 0.594 p < 0.01), MUST and NRS (Kappa = 0.558 p < 0.01). When stratifying the data for elderly patients (age ≥ 60 years), the prevalence of nutritional risk increased for all screening instruments, in particular, the NRE obtained the highest value (61%). ConclusionsMUST and NRE were very similar in identifying patients at nutritional risk, however NRE was found to be superior in elderly patients. In addition, the fact that it does not require direct measurements, makes NRE the most suitable screening tool for emergency units. Funding SourcesResearch and Events Incentive Fund (FIPE) of Hospital de Clínicas de Porto Alegre.