Efficacy of Nutrition Screening Tools in Predicting the Length of Hospital Stay in Older Hospitalized Patients

Objective: The prevalence of malnutrition remains high in older hospitalized patients. Subjective Global Assessment, the Nutrition Risk Screening-2002, and Malnutrition Universal Screening Tool are widely used screening and assessment tools, but comparison of their efficacy in predicting clinical outcomes like length of hospital stay remain scarce. This study aimed to compare the efficacy of these tools in predicting length of hospital stay in a group of older hospitalized patients. Materials and Methods: A retrospective analysis was performed in a sample of 72 patients consecutively admitted to a geriatric medicine ward. Subjective Global Assessment, Nutrition Risk Screening-2002 and Malnutrition Universal Screening Tool were performed within 24 hours of admission. Patients were classified as having prolonged length of hospital stay if they stay in the hospital for more than ten days. The association of baseline malnutrition defined by each tool and the prolonged length of hospital stay was assessed using unadjusted and adjusted logistic regression models. Results: The mean age of the patients was 73.5 ± 6.9 years, and 61.1% were women. The prevalence of malnutrition was 45.8% with Subjective Global Assessment, 51.4% with Nutrition Risk Screening-2002, and 33.3% with Malnutrition Universal Screening Tool. Among the entire cohort, twenty-nine patients (40.2%) had longer length of the hospital stay. After adjusted for covariates, multivariate logistic regression analysis revealed that the Subjective Global Assessment had the best predictive power (OR: 3.9; p: 0.02), followed by Nutrition Risk Screening-2002 (OR: 3.8; p: 0.03), and Malnutrition Universal Screening Tool (OR: 2.9; p: 0.02). Conclusion: Malnutrition assessed by the Subjective Global Assessment, Nutrition Risk Screening-2002 and Malnutrition Universal Screening Tool on admission predict prolonged length of hospital stay in hospitalized older patients.

PDF

___

[1]Norman K, Pichard C, Lochs H, et al. Prognostic impact of disease-related malnutrition. Clinical nutrition 2008; 27:5-15.

[2]Caccialanza R, Klersy C, Cereda E, et al. Nutritional parameters associated with prolonged hospital stay among ambulatory adult patients. Cmaj 2010; 182:1843-1849.

[3]Caccialanza R, Cereda E, Klersy C. Malnutrition, age and inhospital mortality. Cmaj 2011; 183:826-826.

[4]Schneider SM, Al-Jaouni R, Pivot X, et al. Lack of adaptation to severe malnutrition in elderly patients. Clinical Nutrition 2002; 21:499-504.

[5]Sorensen J, Kondrup J, Prokopowicz J, et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clinical nutrition 2008; 27:340-349.

[6]Kelly I, Tessier S, Cahill A, et al. Still hungry in hospital: identifying malnutrition in acute hospital admissions. Qjm 2000; 93:93-98.

[7]Mowé M, Bøhmer T. The prevalence of undiagnosed protein‐calorie undernutrition in a population of hospitalized elderly patients. Journal of the American Geriatrics Society 1991; 39:1089-1092.

[8]Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical nutrition 2017; 36:49-64.

[9]Guaitoli PR, Jansma EP, de Vet HC. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clinical nutrition 2014; 33:39-58.

[10]Kyle ÚG, Kossovsky MP, Karsegard VL, et al. Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clinical Nutrition 2006; 25:409-417.

[11]Detsky AS, Baker J, Johnston N, et al. What is subjective global assessment of nutritional status? Journal of parenteral and enteral nutrition 1987; 11:8-13.

[12]Bolayir B, Arik G, Yeşil Y, et al. Validation of Nutritional Risk Screening‐2002 in a Hospitalized Adult Population. Nutrition in Clinical Practice 2019; 34:297-303.

[13]Elia M. Screening for malnutrition: a multidisciplinary responsibility. Development and use of the Malnutrition Universal Screening Tool (‘MUST’) for adults Redditch: BAPEN 2003.

[14]Wittenberg R, Sharpin L, McCormick B, et al. The ageing society and emergency hospital admissions. Health Policy 2017; 121:923-928.

[15]Covinsky KE, Martin GE, Beyth RJ, et al. The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized medical patients. Journal of the American Geriatrics Society 1999; 47:532-538.

[16]Somanchi M, Tao X, Mullin GE. The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition. Journal of Parenteral and Enteral Nutrition 2011; 35:209-216.

[17]Holyday M, Daniells S, Bare M, et al. Malnutrition screening and early nutrition intervention in hospitalised patients in acute aged care: a randomised controlled trial. The journal of nutrition, health & aging 2012; 16:562-568.

[18]Mendes J, Alves P, Amaral T. Comparison of nutritional status assessment parameters in predicting length of hospital stay in cancer patients. Clinical nutrition 2014; 33:466-470.

[19]Borek P, Chmielewski M, Małgorzewicz S, et al. Analysis of outcomes of the NRS 2002 in patients hospitalized in nephrology wards. Nutrients 2017; 9:287.

[20]Wang F, Chen W, Bruening KS, et al. Nutrition screening tools and the prediction of clinical outcomes among chinese hospitalized gastrointestinal disease patients. PloS one 2016; 11:e0159436.

[21]Martins C, Correia JR, do Amaral TF. Undernutrition risk screening and length of stay of hospitalized elderly. Journal of Nutrition for the Elderly 2006; 25:5-21.

[22]Bohannon RW. Hand-grip dynamometry predicts future outcomes in aging adults. Journal of geriatric physical therapy 2008; 31:3-10.

[23]Amaral TF, Matos LC, Tavares MM, et al. The economic impact of disease-related malnutrition at hospital admission. Clinical nutrition 2007; 26:778-784.

[24]Mozes B, Schiff E, Modan B. Factors affecting inappropriate hospital stay. International Journal for Quality in Health Care 1991; 3:211-217.