Malnutrition Screening Tool Score Research Articles

Implementation of malnutrition screening tool initiative in community cancer center for cycle 1 day 1, change in regimen, and new metastatic disease patients from Sept.–March 2022.

367 Background: Identification of patients at risk for malnutrition is imperative to provide early nutrition intervention. Patients undergoing cancer therapy are at risk for developing a variety of side effects that impact their intake, absorption, and nutritional status while undergoing antineoplastic therapy. Methods: 2021 Q4 Pilot: Implemented Malnutrition Screening Tool (MST) to identify patients at risk of malnutrition for C1D1 patients only during the Nurse Navigator visit. If the MST score is <2, but a patient requests Dietitian Counseling, a patient would be referred to the RD. If score is clinically significant, > or = 2, Nurse Navigator referred to the RD, including rationale and additional detail (i.e., amount of weight loss, poor appetite, etc.). RD reviewed all referrals related to the MST and completes further assessment and intervention if appropriate. 2022 Q4: Screening utilizing the MST was standardized during Nurse Navigator visits for all C1D1 patients, patients with new metastatic disease, patients with change in regimen and new oral therapy patients. Results: See table. Conclusions: Of the patients screened with the NCCN Distress Thermometer, 67% of those patients were identified to be screened for Malnutrition. Of the patients who were screened with the MST, ~ 26% of the patients were identified to be at risk for malnutrition. Early identification of malnutrition in treatment will result in early intervention and assessment by the dietitian to prevent poor outcomes.[Table: see text]

311 Nutrition and dietetics on a Frailty at the Front Door Team, what does it look like?

Abstract Background A dietitian was introduced to the Frailty at the Front Door team (FFDT) in January 2022. The introduction of the Malnutrition Screening Tool (MST) to the Comprehensive Geriatric Assessment (CGA) resulted in a 47% increase in dietetic referrals. The aim of this study was to understand the characteristics of this population and how intervention was initiated. Methods Over a five month period, data was collected from the CGAs administered. Gender, Clinical Frailty Score (CFS), MST score (high risk of malnutrition is defined as MST ≥2), method of referral, patients admitted under a specialty, referrals to Community Nutrition and Dietetics Services (CNDS) and those discharged from dietetics. The data was prospectively entered into an excel spreadsheet and analysed using descriptive statistics. Results 206 frail older adults (≥ 75 yrs) were referred and seen for dietetic intervention. Male to female ratio was 1: 1.75.The mean CFS was 5.8. 89% (n = 183) had MST ≥2. 83% (n = 171) of referrals were made by FFDT, 6% (n = 12) were referred via the hospitals’ electronic referral system. 64% (n = 132) were admitted to the acute hospital while a further 20% (n = 41) were referred to CNDS. The remaining 16% were either transferred to a different hospital or discharged from the dietetics service. Of those admitted, the data was broken down into the top 5 specialities; Geriatrics: 18% (n = 37), Acute Medicine: 16.5% (n = 34), Endocrinology: 12% (n = 25), General Medicine: 10% (n = 20) and Respiratory: 8.2% (n = 17). Conclusion High risk of malnutrition is highly prevalent in frail older adults presenting to the ED and through a number of medical specialties. Increased awareness identifies these patients so that targeted interventions early can reduce adverse outcomes in hospital or the community. Screening for malnutrition with a dietitian embedded in the FFDT identifies a much bigger proportion of those who need intervention than the traditional referral method.

Malnutrition screening tool use in a New Zealand hospital: Reliability and rates of malnutrition screening on admission.

This research aimed to assess the rate and reliability of routine nurse-completed malnutrition screening and report the prevalence of malnutrition risk on admission to Christchurch Hospital. Student dietitians administered the Malnutrition Screening Tool to patients in three speciality wards within 48 h of admission. Student dietitians' Malnutrition Screening Tool scores were compared against documented nurse-completed Malnutrition Screening Tool scores. Data were analysed using descriptive statistics, Fisher's exact test, and Cohen's kappa tests (interrater reliability ⱪ). A p-value <0.05 was considered statistically significant. Student dietitians, using the Malnutrition Screening Tool, screened 360 (96%) of 377 eligible patients while nurses screened 332 (88%) patients. Student dietitians and nurses screened 119 patients (33%) and 63 patients (18%) respectively at risk of malnutrition. There was fair agreement (ⱪ = 0.311) in Malnutrition Screening Tool total scores between nurses and student dietitians. There was a significant difference in the proportion of patients screened at risk of malnutrition between nurses and student dietitians (p < 0.0001). Malnutrition risk remains high in acute care settings. Nurses were less likely to screen patients as at risk of malnutrition than student dietitians. Regular support and training in using Malnutrition Screening Tool may help improve the rate and reliability of routine malnutrition screening.

Taking a Deeper Dive Into Malnutrition and Revision Arthroplasty: When Do Nutritionists Get Involved?

BackgroundPerioperative malnutrition is associated with increased complications and mortality following revision total joint arthroplasty (rTJA). Nutritional consultations are useful in characterizing patient nutritional status but are inconsistently utilized post rTJA. We sought: 1) to describe the prevalence of nutritional consultations post rTJA, 2) to determine if septic rTJA patients needed consultations more often, and 3) if a diagnosis of ‘malnutrition’ from the nutritionist conferred increased readmission rates. MethodsA retrospective study of 2,697 rTJAs performed in a single institution over a 4-year period was performed. Patient demographics, reasons for rTJA, occurrences of nutritional consultation (indicated if body mass index < 20, malnutrition screening tool score ≥ 2, or poor oral intake postoperatively), specific nutritional diagnosis (according to 2020 Electronic Nutrition Care Process Terminology and 90-day readmission rates were recorded and analyzed). Rates of consultations and adjusted logistic regressions were calculated. ResultsThere were 501 patients (18.6%) who required nutritional consultations, with 55 (11.0%) of these patients receiving a ‘malnutrition’ diagnosis. Septic rTJA patients required significantly more nutritional consultations (P < .01) and were significantly more likely to have ‘malnutrition’ (P = .49). A diagnosis of malnutrition was associated with the highest odds of all-cause readmission (odds ratio (OR) = 3.89, P = .01), which was even higher than undergoing a septic rTJA. ConclusionNutritional consultations occur frequently following rTJA. Patients who receive a diagnosis of ‘malnutrition’ through consultation are at significantly higher risk for readmission and require close follow-up. Future efforts are needed to further characterize these patients in order to identify as well as optimize them preoperatively.

Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after electivecolorectal surgery

Background: Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity.Objective: In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care.Design: We conducted a prospective cohort study in adult elective colorectal resection patients after conventional (n = 46) and ERAS (n = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS.Results: Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg-1 · d-1; ERAS group: 0.54 g · kg-1 · d-1; P < 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables (P = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS (P = 0.049) and fewer total infectious complications (P = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; P < 0.001), and the consumption of ≥60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: -6.8, -2.0 d; P < 0.001).Conclusions: ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS. This trial was registered at clinicaltrials.gov as NCT02940665.

Identification of Malnutrition Risk Using Malnutrition Screening Tool in an Ambulatory Pancreas Clinic.

The aim of this project was to assess malnutrition risk in a well-defined cohort of pancreatic diseases. We performed a retrospective, cross-sectional study of 401 subjects with available malnutrition screening tool scores who received care at a single outpatient pancreas clinic during a 6-month study period. Univariate analyses were performed to compare demographic, anthropometric, symptoms/diseases, and risk for malnutrition characteristics across 3 strata of diseases: acute pancreatitis (n = 141), chronic pancreatitis (n = 193), and other pancreatic diagnoses (n = 67). A total of 18% of subjects were identified as at risk for malnutrition, including 25% who reported involuntary weight loss and/or decreased appetite. Subjects categorized as at risk for malnutrition were more likely to have gastrointestinal symptoms. Although the nutrition consultation rates were higher in subjects at risk for malnutrition (P = 0.03), 66% did not receive a clearly indicated dietary evaluation or management recommendations. One fifth of all patients in an ambulatory pancreas clinic are identified as at risk for malnutrition using a simple, validated tool. The majority of patients at increased risk for nutritional complications did not receive nutritional recommendations.

A Novel Nomogram for Early Identification and Intervention in Colorectal Cancer Patients at Risk for Malnutrition.

Malnutrition is under-recognized in cancer patients and can lead to poor treatment outcomes. We aim to develop an outpatient-focused score based on the Malnutrition Screening Tool (MST) to help identify colorectal cancer (CRC) profiles at high risk for malnutrition. 506 CRC patients during initial outpatient oncology consultation at our tertiary referral outpatient oncology clinic completed the MST. Objective and subjective data were collected through chart review. Data gathered are as follows: demographics, anthropometrics, laboratory values, patient-reported symptoms, MST score, cancer history, performance status, socioeconomic status, and Charlson Comorbidity. Predictors of malnutrition were identified by logistic regression. Receiver operating curve (ROC), area under the curve (AUC), and our model's predictability were determined. Significant predictors of malnutrition are as follows: younger age (20-39 vs >40 years) (P = .007), normal-to-low body mass index at presentation (P = .019), Eastern Cooperative Oncology Group classification 2-3 (P = .012), metastatic disease (P = .046), albumin <3.0g/dL (P = .033), fatigue (P < .001), and change in stool/bowel habits (P = .002). In our derived malnutrition score, risk of malnutrition increased from 11% for score 0, to 100% for scores 9-10. Receiver operating curve showed AUC .745 (95% CI, .697-.793). An outpatient clinic-derived malnutrition score obtained from objective and patient-reported variables may facilitate identification of CRC patients at highest risk for malnutrition. Rapid identification and intervention in high-risk patients may improve treatment recovery, therapy tolerance, and quality of life. Our tool requires external validation before application in clinical practice.

Zinc Deficient Intake in Hemodialysis Patients: A Path to a High Mortality Risk

Zinc is essential for human nutrition and plays an important role in hemodialysis (HD) patients. The aim of this study is to analyze the relationship between zinc intake and mortality in HD patients. This is a longitudinal, prospective, multicenter study with 582 HD patients from 37 dialysis centers. We recorded clinical and body composition parameters. Dietary intake and physical activity data were obtained using the Food Frequency Questionnaire and International Physical Activity Questionnaire. All statistical tests were performed using SPSS 24.0 software. A P value lower than 0.05 was considered statistically significant. Patients' mean age was 67.8±17.7years and median HD vintage was 65 (43-104) months. About 53.6% of the patients presented a deficient daily intake of zinc. Patients with the highest zinc intake were those who had a higher lean tissue index (P=.022), energy (P<.001), and protein (p=.022) intakes. Zinc intake was positively correlated with energy (r=0.709) and protein intake (r=0.805) and negatively correlated with the malnutrition screening tool score (r=-0.087). A higher energy, protein, and lower carbohydrates intake, as well as lower HD vintage and higher lean tissue index were predictors of zinc intake. A higher mortality risk was observed in patients with zinc intake below the recommended values, even after the adjustment for age, presence of diabetes, gender, dialysis vintage, albumin, lean tissue index, energy intake/kilogram, and level of physical activity (P=.021). There is a high prevalence of HD patients with an inadequate zinc intake, which is related to worse nutritional and body composition parameters and with a higher mortality risk.

Monitoring Rates of Malnutrition Risk in Outpatient Cancer Centers Utilizing the Malnutrition Screening Tool Embedded into the Electronic Health Record

BackgroundThe risk of malnutrition in patients with cancer is well documented. However, screening to identify patients at risk in ambulatory cancer centers is not standardized nor uniform. The 2-question Malnutrition Screening Tool (MST) is validated in the ambulatory oncology setting and endorsed by the Academy of Nutrition and Dietetics. ObjectiveTo test the feasibility of operationalizing and standardizing malnutrition risk assessment across 2 large ambulatory cancer centers by embedding the MST into the electronic health record (EHR) with the goal of identifying and quantifying the prevalence of malnutrition risk in outpatient settings. DesignA Quality Assurance Performance Improvement project was conducted to evaluate malnutrition screening practices by leveraging the EHR. Work standards were developed, implemented, and evaluated to assess the feasibility of utilizing de-identified MST data, entered as discrete variables in an EHR flowsheet, to track monthly MST completion rates and to identify and quantify patients being treated for cancer scoring at risk for impaired nutritional status. Participants/settingData from 2 large adult ambulatory community cancer centers in the upper Midwest were collected between April 2017 and December 2018. ResultsOver a 20-month period, the average monthly MST completion rate was 74%. Of those with completed MST screens, the average percentage of patients identified at nutritional risk (MST score ≥2) was 5% in medical oncology and 12% in radiation oncology. ConclusionIt is feasible to (1) integrate and standardize data collection of the MST into existing EHR flowsheets and (2) identify and quantify patients at risk for malnutrition on a consistent basis.

Association of Markers of Nutrition Status and COVID 19 Outcomes

describe indicators of risk for malnutrition and/or malnutrition associated with poor outcomes in COVID+ patients. Due to the nature of COVID-19, nutrition-related recommendations for assessment are largely based on expert opinion and general data for critical illness. Additionally, there is a lack of information examining the relationship between nutrition status and COVID related outcomes. The purpose of this quality improvement initiative was to determine the relationship between markers of nutrition status and outcomes in COVID+ patients. All COVID+ patients admitted to three hospitals over a two-month period in an urban health system (one academic medical center and two community hospitals) were included. All data were collected via the electronic medical record. The Malnutrition Screening Tool (MST) was used to assess risk for malnutrition. Malnutrition was determined according to AND/ASPEN guidelines. Data were grouped as expired versus survived and discharged home versus not discharged home. A total of 588 patients tested positive with 107 of these patients (18%) expiring and 376 (64%) discharging home . Patients who expired or were not discharged home were significantly older, had low BMIs and had longer hospital LOS, ICU LOS, and vent days. Fewer MST screens were completed on these patients than their counterparts. No differences were seen in rates of malnutrition among the groups. Inability to complete NFPE likely affected rates of malnutrition diagnosis. Due to the severity of illness of many patients, nursing staff were likely unable to complete the MST. RDNs may consider screening all critically ill COVID+ patients regardless of MST score. Additional research is needed to determine the impact of nutrition interventions.

Nutritional risk is associated with an increase of in-hospital mortality and a reduction of being discharged home: Results of the 2009-2015 nutritionDay survey.

Disease-related malnutrition is a known factor for poor outcomes. However, there is a lack of knowledge about the prevalence and the impact of nutritional risk on outcomes in Colombia. The aim of the present study was to determine the prevalence of nutritional risk, to know how nutrition screening is routinely performed and to determine the impact of nutritional risk on the outcomes of in-hospital mortality and being discharged home outcomes. We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples (2009-2015) including a total of 7,994 adult patients in 248 units in Colombia. Data is contrasted with the Latin American and worldwide results. The prevalence of nutritional risk was determined according to the malnutrition screening tool (MST). The impact of nutritional risk in Colombian patients regarding outcomes was assessed by a Fine and Gray competing risk regression model controlling for PANDORA score (age, BMI, length of stay before nutritionDay, cancer diagnosis, and mobility). The prevalence of nutritional risk (MST score≥2) in Colombia was 38%, 41% in Latin America, and 32% worldwide. Half of the Colombian units screened patients for malnutrition or nutritional risk on admission to hospital, compared to 80% in Latin America and 62% worldwide. Only 23% of the Colombian patients identified as being at nutritional risk in the nutritionDay survey received any nutritional therapy. The hospital mortality hazard ratio of Colombian patients at nutritional risk defined by MST was 1.94 (95% CI, 1.53,2.46; p<0.001) and 0.82 of being discharged home (95% CI, 0.76,0.88, p<0.001). This is the first large-scale study in Colombia evaluating the impact of nutritional risk on clinical outcomes showing an increase of in-hospital mortality and a reduction of being discharged home. Moreover, the study shows that nutritional risk is still highly prevalent worldwide implying the need to promote an optimal nutritional care. The participation of Latin American countries in the nutritionDay survey is an opportunity to increase knowledge and awareness of these issues.

Malnutrition Screening: An Interprofessional Approach in Outpatient Oncology.

Malnutrition is highly prevalent in the oncology population and is associated with poor treatment outcomes. This study aimed to implement a malnutrition screening process using a validated tool in three outpatient cancer centers. Nursing and nutrition department leaders collaborated to establish malnutrition screening. The Malnutrition Screening Tool (MST) was embedded in the electronic health record. Based on the MST, a score of 2 or greater is considered at risk for malnutrition. Nurses were educated on screening all patients completing their first cycle of infusion chemotherapy. Data were collected for six months. Interprofessional collaboration established a process to implement malnutrition screening. Twenty-eight percent of patients with cancer were at risk for malnutrition. Fifty-three percent were at risk for malnutrition based on MST scores of 2. Compliance with the MST at first infusion visit was 30%-81% across the three cancer centers.

A comparative study of three nutritional risk screening tools in surgical inpatients with laryngeal cancer.

Nutritional screening has been recommended for hospitalized patients. The goal of this study was to compare the screening value of Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Malnutrition Screening Tool (MST) in inpatients with laryngeal cancer, and to identify which is the most accurate. An observational cross-sectional study of 197 laryngeal cancer patients admitted for surgery was conducted using continuous sampling. NRS-2002, MUST, and MST were used to screen the nutritional risk of patients after admission and before discharge. Diagnostic information and the length-of-hospital stay (LOS) data were extracted from the hospital HIS system. The detection rates of NRS-2002, MUST, and MST in admission or discharge patients were 14.7%/27.9%, 22.3%/26.9%, and 4.6%/11.2%, respectively. Using NRS-2002 as the reference, high sensitivity (82.8%) and a Kappa coefficient (k=0.584) were achieved using MUST in admission patients, while MST presented the lowest sensitivity (17.3%) and Kappa coefficient (k=0.208). MST maintained low sensitivity (25.5%) and Kappa coefficient (k=0.243) in discharge patients. NRS-2002 ≥3 was an independent risk factor for longer LOS in patients with laryngeal cancer (odds ratio (OR)=5.59, 95% confidence interval (CI)=1.86-16.81, p=0.002). The MUST and MST scores did not predict long LOS. Compared with NRS-2002, MUST is superior to MST in sensitivity, specificity, and Kappa coefficient. NRS-2002 better identified patients at risk for longer LOS, but a consistent conclusion was not reached with MUST and MST. Further validation in larger samples is needed.

Assessing the Concurrent Validity and Interrater Reliability of Patient-Led Screening Using the Malnutrition Screening Tool in the Ambulatory Cancer Care Outpatient Setting

BackgroundThe prevalence of malnutrition in cancer patients is reported as high as 65%; however, malnutrition screening is often substandard. The Malnutrition Screening Tool (MST) has been validated for use by health care professionals to detect at-risk patients; however, there is a gap in the literature regarding validation of patient-led MST screening. ObjectiveThe aim of the study was to assess the concurrent validity of patient-led MST against the Subjective Global Assessment (SGA) and the interrater reliability of patient-led MST against dietitian-led MST in patients attending ambulatory cancer care services for chemotherapy or supportive treatments. Design/participantsA single-site diagnostic accuracy study of 201 patients between May and June 2017 attending the ambulatory cancer care setting at an Australian metropolitan tertiary hospital in Queensland. Main outcome measurementsThe primary outcome measures were concurrent validity and interrater reliability of MST scores as determined by patients (patient-MST), dietitians (dietitian-MST), and SGA as completed by the dietitian. Statistical analysisConcurrent validity of patient-led MST scores against the SGA was determined using specificity, sensitivity, positive predictive values, and negative predictive values. Interrater reliability of patient-MST and dietitian-MST was assessed using κ coefficient. ResultsThe ability of the patient-led MST scores (0 to 1 vs 2 to 5) to indicate nutrition status was found to have a sensitivity of 94% (95% CI 81% to 99%), a specificity of 86% (95% CI 79% to 91%), and an area under the receiver operating characteristic curve of 0.93 (95% CI 0.89 to 0.96). The positive predictive value was 59% (95% CI 45% to 71%), and the negative predictive value was 99% (95% CI 95% to 100%). A weighted κ of 0.83 (95% CI 0.82 to 0.87) between patient-MST and dietitian-MST was found. ConclusionPatient-led MST screening is a reliable and valid measure that can accurately identify ambulatory cancer care patients as at risk or not at risk of malnutrition.

Utilizing technology for malnutrition screening and referrals to nutrition services.

284 Background: The incidence of disease-related malnutrition in oncology patients ranges from 40-80%. This is the highest of all hospital patient groups. Malnutrition is associated with decreased quality of life, increased healthcare costs and intolerance to treatment. Screening for nutrition risk is often lacking in outpatient settings. Electronic health records could be utilized to improve the delivery of validated nutrition screening tools such as the Malnutrition Screening Tool (MST) in outpatient oncology settings. Methods: We designed a pilot project (Feb-July 2018) to administer the MST for outpatient oncology patients seen at the Fred and Pamela Buffett Cancer Center (FPBCC) using an electronic medical record system. “Best Practice Alerts” (BPAs) were used to notify the nursing staff of a patient with a screen that was positive for nutrition risk (MST score ≥3). The BPA recommended a referral to nutrition services; nursing staff could choose to “order” or “do not order" a Nutrition Consult. Results: A total of 2,672 patients received MST screening during the pilot. Out of these, 223 (8%) had a positive screen for nutrition risk; 197 of these were eligible for a nutrition services referral. A BPA “fired” 152 times out of 197 eligible patients (77%). Of the197 eligible patients, 58 (29%) were actually referred to nutrition services. Of these 58 referrals, 43 (74%) were triggered based on a BPA, while the remaining referrals were received outside of a BPA. BPAs failed to fire 45/197 times (23%). Conclusions: An EHR-based nutrition screening system to increase referrals in patients identified at nutrition risk in an outpatient oncology setting was effective for 29% of eligible patients. Barriers encountered included failures in technology as well as human factors. During the pilot it was discovered that the BPA was firing in a location in the chart where the nurse did not regularly work. There was not a consistent message as to the goals and outcomes during the pilot which resulted in lack of awareness by nurses to respond to the nutrition risk score. Utilizing an EHR-based nutrition screening tool is an effective way to identify patients at risk and refer them to appropriate resources in a timely and efficient way.

Scoring Using the Malnutrition Screening Tool: Dietetic Intern and Registered Nurse

To assess the number of patients that receive malnutrition screening and the accuracy of said screening on patients admitted to a large research-based teaching hospital. At the University of Virginia Health System (UVAHS), the Malnutrition Screening Tool (MST) is intended to be completed by registered nurses (RNs) within 24 hours of adult inpatient admission. The recent small, random audits at UVAHS have shown that 75% of patients are screened for malnutrition. More robust data are needed to better quantify the percentage of patients that receive an MST by nursing. Additionally, accuracy of the MST by nursing will be useful in determining whether education and/or systems changes are needed to improve screening processes. Malnutrition screening is an important first step in identifying hospitalized inpatients at risk for increased lengths of stay, mortality, and morbidity. The dietetic intern completed the MST using a paper form one day per week for 7 weeks. A list of newly admitted adult patients was gathered from the electronic medical report inpatient length of stay at UVAHS within 1 hour of the dietetic intern conducting MST screenings. A total of 85 patients were screened by the dietetic intern. After the MST was conducted, information was gathered from patients medical records: age, sex, admission date and time, unit, primary diagnosis, nursing completion of the MST, and nursing MST score (if applicable). A Weighted Cohens Kappa test was used to assess interrater reliability between the dietetic intern and nursing, including the probability that the scores were the same by chance. Nursing screened 67 out of the 85 patients (78.8%) seen by the dietetic intern. The Weighted Cohens Kappa test showed moderate interrater reliability between dietetic intern and nursing scores (Kappa score = 0.498). Out of a total of 85 patients screened for malnutrition by the dietetic intern, 20 out of the 85 (24%) were not triggered to see a registered dietitian nutritionist (RDN) due to nursing either not filling out the MST or filling it out incorrectly. Twelve out of the 67 (18%) patients screened by RNs as not being at risk were at risk for malnutrition based on dietetic intern screening. Eight out of 18 (44%) patients that nursing did not screen were at risk for malnutrition based on dietetic intern screening. Nursing screened 78.8% of patients for malnutrition using the MST. This is slightly higher than 75% that was seen in recent small random audits completed at UVAHS. Twenty out of 85 (24%) patients were missed due to nursing either not filling out the MST or filling it out incorrectly. Results indicate a potential knowledge deficit amongst nursing regarding how to conduct malnutrition screening. Results also indicate a need for improved compliance with use of the MST to ensure at-risk patients are referred to RDNs.

Effect of Early Recognition of Malnutrition and Targeted Nutrition Support on Clinical Outcomes in Autologous Stem Cell Transplant Patients

Objective Patients (pts) admitted to hospital for autologous stem cell transplant (ASCT) are at risk for malnutrition. American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines recommend nutrition screening and targeted nutrition support for ASCT pts. However, these recommendations are not always followed due to lack of clear evidence of benefit and concern that nutrition support may be associated with increased risk of infection or delayed time to platelet engraftment. We evaluated clinical outcomes in consecutive ASCT pts receiving nutrition assessment and targeted nutrition support based on malnutrition status. Methods A historical control group included consecutive pts admitted for ASCT January 2016 to October 2017 (n = 308). Beginning in October 2017, all ASCT pts (n = 148) received nutrition assessment and intervention to optimize oral intake and were included in the intervention group. Pts diagnosed with malnutrition using Academy of Nutrition and Dietetics-ASPEN criteria and continuing with 15 days after transplant. Pt characteristics included age, Karnofsky performance status (KPS), first vs. subsequent ASCT, and malnutrition risk indicated by a score ≥2 on the validated Malnutrition Screening Tool (MST). Mann-Whitney U tests comparing patients vs. historical controls and logistic regressions were conducted using SPSS (version 25), with p Results Forty-nine pts (33%) met criteria for EN/PN, 40 of whom (82%) received one or both interventions. One pt received EN alone, 37 PN alone, and two EN + PN, for a mean duration of 9.05 days. Pts in the intervention group had lower odds of prolonged LOS (OR = 0.484, 95% CI: 0.259-0.906) and CLABSI (OR = 0.259, 95% CI: 0.073-0.925) in models controlled for age, KPS, first vs. subsequent ASCT, and MST score, with no difference in days to platelet engraftment (p = 0.987). No pt receiving PN or EN was diagnosed with CLABSI. ICU transfer and 30 day readmission rates did not differ between groups Conclusion Identifying malnutrition, optimizing oral intake and providing early, targeted nutrition support to ASCT pts can improve clinical outcomes.

Prevalence of Malnutrition Risk and the Impact of Nutrition Risk on Hospital Outcomes: Results From nutritionDay in the U.S.

Malnutrition risk estimates vary greatly, and no robust data on the association between food intake and outcomes exist for hospitals in the United States (U.S.). This study aimed to determine the prevalence of malnutrition risk and to evaluate the impact of food intake on mortality using the nutritionDay in the U.S. dataset. This study analyzed data from 2009 to 2015 for all adult patients from participating hospitals. Prevalence of malnutrition risk was determined by mapping self-reported nutritionDay survey questions to the Malnutrition Screening Tool (MST). Fine and Gray competing-risk analysis with clustering was used to evaluate the impact of nutrition risk and food intake on patients' 30-day in-hospital mortality, while controlling for age, mobility, and other disease-related factors. Analysis included data from 9959 adult patients from 601 wards. The overall prevalence of malnutrition risk (MST score ≥2) was 32.7%. On nutritionDay, 32.1% of patients ate a quarter of their meal or less. Hospital mortality hazard ratio was 3.24 (95% CI: [1.73, 6.07]; P-value < 0.001) for patients eating a quarter compared with those who ate all their meal and increased to 5.99 (95% CI: [3.03, 11.84]; P-value < 0.0001) for patients eating nothing despite being allowed to eat. This study provides the most robust estimate of malnutrition risk in U.S. hospitalized patients to date, finding that approximately 1 in 3 are at risk. Additionally, patients who have diminished meal intake experience increased mortality risk. These results highlight the ongoing issue of malnutrition in the hospital setting.

Malnutrition screening: A screening tool for outpatient oncology patients, leveraging EMR data.

275 Background: The provision of adequate nutritional care in outpatient cancer centers was the focus of a 2016 NAS Workshop, “Assessing Nutrition Care in Outpatient Oncology.” Here we report our internal project evaluating ongoing documentation of a malnutrition screening tool (MST) at 3 national cancer centers (CC). Methods: Screening scores from a validated 2 question MST scale were entered into the EMR. Questions probe for: 1) unintentional weight loss; and 2) eating poorly because of a decreased appetite. A score of ≥ 2 indicated nutrition risk. De-identified oncology clinic visit data were examined monthly to assess MST utilization and scores for radiation and medical oncology patients across the CC’s. Results: Approximately two-thirds (67%) of unique medical oncology patients that visited the CC’s had documented MST data with 9% (n = 144,129) scoring at nutritional risk. MST completion rates were higher in radiation oncology clinics secondary to staff education. Of those that had a valid MST score in radiation clinics, 13% (n = 23,202) of MST scores indicated nutritional risk. Conclusions: The MST is a valid malnutrition screening tool for outpatient oncology patients, yet this tool is not uniformly being utilized nationally. Consistent use of the MST in the electronic medical record and leveraging data on utilization are needed to inform staff compliance, consistency in care, future dietitian staffing patterns, cost/benefit analysis, and health outcomes for oncology patients. [Table: see text][Table: see text]

Dysphagia in older persons following severe burns: Burn location is irrelevant to risk of dysphagia and its complications in patients over 75 years

BackgroundManagement of burns in older persons is complex with evidence indicating advanced age is associated with elevated risk for morbidity and mortality. Dysphagia and its sequelae may further increase this risk. Aims(1) Determine the prevalence, and (2) identify risk factors for dysphagia in patients admitted with severe burn injury over 75 years. MethodsAll patients >75 years admitted to Concord Repatriation General Hospital with severe burn injury over a 4-year period (2013–2017) were assessed for dysphagia on presentation and continually monitored throughout their admission. Burn injury, demographic and nutritional data were captured and analysed for association with and predictive value for dysphagia. ResultsSixty-six patients (35 male; 31 female) aged 75–96 years (median 82 years) were recruited. Dysphagia was identified in 46.97% during their hospital admission. Dysphagia was significantly associated with burn size, pre-existing cognitive impairment, mechanical ventilation, duration of enteral feeding, hospital length of stay, in-hospital complications and mortality. No association was identified between burn location, burn mechanism, surgery and dysphagia. Burn size and Malnutrition Screening Tool score were found to be independent predictors for dysphagia. ConclusionsDysphagia prevalence is high in older persons with burns and is associated with increased morbidity and mortality, regardless of burn location.