The evaluation of an undernutrition risk score to be used by nursing staff in a teaching hospital to identify surgical patients at risk of malnutrition on admission: a pilot study

Abstract

Background The purpose of this study was to evaluate an undernutrition risk score (URS) developed by the Dietetic Department of an acute tertiary referral hospital in Dublin with the aim that the URS could be used by nursing staff, to identify surgical patients at risk of malnutrition on admission. Methods Forty surgical patients (16 males and 24 females) were recruited, within 5 days of admission. A standard objective nutritional assessment was carried out on each patient. This consisted of a 3-day diet history, anthropometric indices including: weight, armspan, mid-upper arm circumference, mid-arm muscle circumference and hand grip dynamometry. A nutrition risk index (NRI) screening tool was also used by a single observer to categorize patients as having low, moderate or severe risk of malnutrition. The indices used for the NRI were serum albumin and percentage weight loss. The URS assessed patients with respect to changes in weight and appetite, gut function and disease status and was completed by nursing staff by interview for each of the patients recruited. Results The URS was successful in detecting 71.4% (n = 10) of surgical patients who were classified as being at some risk (moderate/severe) for undernutrition by the NRI. However, 11.8% (n = 4) of the patients who were categorized by the NRI as being at moderate risk for undernutrition were classified as being at low risk by the nursing staff using the URS. The URS was found to be most sensitive in the detection of those at low or severe risk for undernutrition and least sensitive for those at moderate risk. Conclusion The undernutrition risk score in this study provided an accurate and consequently useful screening tool that could be used for surgical patients who are capable of feeding themselves independently.