Nutritional risk screening in surgery: Valid, feasible, easy!

Abstract

We aimed to test the capacity in identifying patients at nutritional risk, by comparing BMI, recent %weight loss,Nutritional Risk Screening 2002(NRS-2002),Malnutrition Universal Screening Tool(MUST) and Nutritional Risk Index(NRI) with Subjective Global Assessment(SGA),considered the Standard. The main purpose was to select the most consistent screening method for effective integration in daily surgical wards' practice. 300 surgical patients were assessed at admission: BMI(categorized by WHO's criteria), weight loss ≥ 5% in previous 6 months, NRS-2002, MUST, NRI, SGA. Concordances, correlations, sensitivity, specificity, positive(PPV) and negative predictive values(NPV) were calculated to evaluate methods' performance vs the Standard. Prevalence of nutritional risk was 66% by NRS-2002 + MUST, and 87% by NRI. By SGA, 64% patients were undernourished. All methods agreed with SGA(k = 0.85-0.91,p < 0.001), except BMI & NRI(k = 0.07-0.34,p < 0.05). NRS-2002, MUST and %weight loss effectively detected patients at risk: sensitivity 0.8-0.89, specificity 0.89-0.93, PPV 81%-89%, NPV 89%-100%. Conversely, BMI & NRI were ineffective: sensitivity 0.29-0.43, specificity 0.27-0.39, PPV 24%-35%, NPV 27%-31%; %weight loss alone vs MUST/NRS-2002 was explored: sensitivity 0.79-0.87, specificity 0.85-0.89, PPV 84%-85%, NPV 87%-89%, thus successfully identifying undernutrition risk. In surgical patients, MUST + NRS-2002 are valid for nutritional screening; recent weight loss ≥ 5% also proved highly efficient; its easy/quick calculation may facilitate adherence/integration by health professionals as a minimum obligatory in clinical practice.