帝国营养筛查系统（INSYST）的有效性、可靠性和可接受性：一种不依赖体重指数的工具。

Validity, reliability and acceptability of the Imperial Nutritional Screening System (INSYST): a tool that does not require the body mass index.

机构信息

Imperial College Healthcare NHS Trust, Department of Nutrition and Dietetics, Charing Cross Hospital, London, UK.

出版信息

J Hum Nutr Diet. 2009 Dec;22(6):536-44. doi: 10.1111/j.1365-277X.2009.01004.x.

DOI:10.1111/j.1365-277X.2009.01004.x

PMID:20002950

Abstract

BACKGROUND

Nutritional screening tools are central to identifying malnourished patients, but their efficacy is often reduced as a result of difficulties in obtaining height for body mass index (BMI) calculations. The present study aimed to evaluate the validity, reliability and acceptability of the Imperial Nutritional Screening System (INSYST); a tool that does not require the BMI.

METHODS

Patients were screened by the researcher within 72 h of admission using INSYST I & II, Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment (MNA), including taking height and weight. Routine INSYST data, completed by nursing staff, were subsequently collected. At risk and malnourished patients were combined for statistical analysis. Inter-tool and inter-rater agreement (kappa, kappa) was evaluated. Sensitivity and specificity were calculated. Nurses were timed using INSYST. Acceptability, including ease and speed of use, was evaluated.

RESULTS

Kappa (agreement) scores (all P < 0.001) were substantial for INSYST I versus MUST and MNA (kappa = 0.73 and kappa = 0.76, respectively) and moderate for INSYST II (both kappa = 0.53). The sensitivity of INSYST I and II was high (95-100%), whereas specificity was lower (65-83%). The agreement between dietitian and nurse for INSYST I was substantial kappa = 0.77 and that for INSYST II was fair kappa = 0.39 (both P <or= 0.001). There was little disagreement for INSYST I, although nurses tended to underestimate malnutrition risk when using INSYST II. INSYST I took a median of 60 s to complete, INSYST II took 102 s and weighing took 100 s, giving a total time of approximately 5 min. Likert scales showed that the majority of nurses scored INSYST as being fast and easy to use.

CONCLUSIONS

INSYST has shown promising levels of concurrent validity (versus MUST and MNA), inter-rater reliability and acceptability, suggesting that BMI (and therefore height) is unnecessary for identifying malnourished patients.

摘要

背景

营养筛选工具是识别营养不良患者的核心，但由于获得身体质量指数（BMI）计算所需身高的困难，其功效往往会降低。本研究旨在评估 Imperial Nutritional Screening System（INSYST）的有效性、可靠性和可接受性；这是一种不需要 BMI 的工具。

方法

在入院后 72 小时内，研究人员使用 INSYST I 和 II、营养不良通用筛选工具（MUST）和微型营养评估（MNA）对患者进行筛查，包括测量身高和体重。随后收集常规 INSYST 数据，由护理人员完成。对有风险和营养不良的患者进行统计分析。评估工具间和评分者间的一致性（kappa、kappa）。计算灵敏度和特异性。记录护士使用 INSYST 的时间。评估可接受性，包括易用性和速度。

结果

INSYST I 与 MUST 和 MNA 的kappa（一致性）评分（均 P<0.001）较高（kappa=0.73 和 kappa=0.76），而 INSYST II 的 kappa 评分适中（均 kappa=0.53）。INSYST I 和 II 的灵敏度均较高（95-100%），而特异性较低（65-83%）。营养师和护士对 INSYST I 的一致性较高，kappa=0.77，而对 INSYST II 的一致性较低，kappa=0.39（均 P<0.001）。尽管护士在使用 INSYST II 时往往低估营养不良风险，但对 INSYST I 的意见分歧不大。INSYST I 完成的中位数时间为 60 秒，INSYST II 为 102 秒，称重时间为 100 秒，总时间约为 5 分钟。Likert 量表显示，大多数护士认为 INSYST 速度快且易于使用。