Kruizenga Hinke M, Van Tulder Maurits W, Seidell Jaap C, Thijs Abel, Ader Herman J, Van Bokhorst-de van der Schueren Marian A E
Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands.
Am J Clin Nutr. 2005 Nov;82(5):1082-9. doi: 10.1093/ajcn/82.5.1082.
About 25-40% of hospital patients are malnourished. With current clinical practices, only 50% of malnourished patients are identified by the medical and nursing staff.
The objective of this study was to report the cost and effectiveness of early recognition and treatment of malnourished hospital patients with the use of the Short Nutritional Assessment Questionnaire (SNAQ).
The intervention group consisted of 297 patients who were admitted to 2 mixed medical and surgical wards and who received both malnutrition screening at admission and standardized nutritional care. The control group consisted of a comparable group of 291 patients who received the usual hospital clinical care. Outcome measures were weight change, use of supplemental drinks, use of tube feeding, use of parenteral nutrition and in-between meals, number of consultations by the hospital dietitian, and length of hospital stay.
The recognition of malnutrition improved from 50% to 80% with the use of the SNAQ malnutrition screening tool during admission to the hospital. The standardized nutritional care protocol added approximately 600 kcal and 12 g protein to the daily intake of malnourished patients. Early screening and treatment of malnourished patients reduced the length of hospital stay in malnourished patients with low handgrip strength (ie, frail patients). To shorten the mean length of hospital stay by 1 d for all malnourished patients, a mean investment of 76 euros (91 US dollars) in nutritional screening and treatment was needed. The incremental costs were comparably low in the whole group and in the subgroup of malnourished patients with low handgrip strength.
Screening with the SNAQ and early standardized nutritional care improves the recognition of malnourished patients and provides the opportunity to start treatment at an early stage of hospitalization. The additional costs of early nutritional care are low, especially in frail malnourished patients.
约25%-40%的住院患者存在营养不良。按照目前的临床实践，医护人员仅能识别出50%的营养不良患者。
本研究的目的是报告使用简易营养评估问卷（SNAQ）对住院营养不良患者进行早期识别和治疗的成本及效果。
干预组由297例入住2个内科和外科混合病房的患者组成，这些患者在入院时接受了营养不良筛查并接受了标准化营养护理。对照组由291例接受常规医院临床护理的类似患者组成。观察指标包括体重变化、补充饮料的使用、管饲的使用、肠外营养和加餐的使用、医院营养师的会诊次数以及住院时间。
在患者入院期间使用SNAQ营养不良筛查工具后，营养不良的识别率从50%提高到了80%。标准化营养护理方案使营养不良患者的每日摄入量增加了约600千卡热量和12克蛋白质。对营养不良患者进行早期筛查和治疗缩短了握力较低（即身体虚弱）的营养不良患者的住院时间。对于所有营养不良患者，要使平均住院时间缩短1天，在营养筛查和治疗方面平均需要投入76欧元（91美元）。在整个组以及握力较低的营养不良患者亚组中，增量成本相对较低。
使用SNAQ进行筛查和早期标准化营养护理可提高对营养不良患者的识别率，并为在住院早期开始治疗提供机会。早期营养护理的额外成本较低，尤其是在身体虚弱的营养不良患者中。
