Lim Su-Lin, Tong Chung-Yan, Ang Emily, Lee Evan Jon-Choon, Loke Wai-Chiong, Chen Yuming, Ferguson Maree, Daniels Lynne
Dietetics Department National University Hospital, 5 Lower Kent Ridge Road, Singapore.
Asia Pac J Clin Nutr. 2009;18(3):395-403.
It is important to detect and treat malnutrition in hospital patients so as to improve clinical outcome and reduce hospital stay. The aim of this study was to develop and validate a nutrition screening tool with a simple and quick scoring system for acute hospital patients in Singapore. In this study, 818 newly admitted patients aged above 18 years old were screened using five parameters that contribute to the risk of malnutrition. A dietitian blinded to the nutrition screening score assessed the same patients using the reference standard, Subjective Global Assessment (SGA) within 48 hours. Sensitivity and specificity were established using the receiver operator characteristics (ROC) curve and the best cut-off scores determined. The nutrition parameter with the largest area under the ROC curve (AUC) was chosen as the final screening tool, which was named the 3-Minute Nutrition Screening (3-MinNS). The combination of the parameters weight loss, intake and muscle wastage (3-MinNS), gave the largest AUC when compared with SGA. Using 3-MinNS, the best cut-off point to identify malnourished patients is three (sensitivity 86%, specificity 83%). The cut-off score to identify subjects at risk of severe malnutrition is five (sensitivity 93%, specificity 86%). The 3-Minute Nutrition Screening is a valid, simple and rapid tool that identifies acute hospital patients at risk of malnutrition in Singapore. It is able to differentiate patients at risk of moderate malnutrition and severe malnutrition for prioritization and management purposes.
在医院患者中检测和治疗营养不良对于改善临床结局及缩短住院时间至关重要。本研究的目的是为新加坡的急性病住院患者开发并验证一种具有简单快速评分系统的营养筛查工具。在本研究中，对818名年龄在18岁以上的新入院患者使用五个导致营养不良风险的参数进行了筛查。一名对营养筛查评分不知情的营养师在48小时内使用参考标准主观全面评定法（SGA）对相同患者进行评估。使用受试者工作特征（ROC）曲线确定敏感性和特异性，并确定最佳截断分数。选择ROC曲线下面积最大（AUC）的营养参数作为最终筛查工具，命名为3分钟营养筛查（3-MinNS）。与SGA相比，体重减轻、摄入量和肌肉消耗（3-MinNS）参数的组合具有最大的AUC。使用3-MinNS，识别营养不良患者的最佳截断点为3分（敏感性86%，特异性83%）。识别严重营养不良风险患者的截断分数为5分（敏感性93%，特异性86%）。3分钟营养筛查是一种有效、简单且快速的工具，可识别新加坡急性病住院患者中的营养不良风险。它能够区分中度营养不良和重度营养不良风险患者，以便进行优先级排序和管理。
