Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Cancer Nurs. 2011 Sep-Oct;34(5):410-6. doi: 10.1097/NCC.0b013e318206b013.
Malnutrition is prevalent among patients within certain cancer types. There is lack of universal standard of care for nutrition screening and a lack of agreement on an operational definition and on validity of malnutrition indicators.
In a secondary data analysis, we investigated prevalence of malnutrition diagnosis with 3 classification methods using data from medical records of a National Cancer Institute-designated comprehensive cancer center.
Records of 227 patients hospitalized during 1998 with head and neck, gastrointestinal, or lung cancer were reviewed for malnutrition based on 3 methods: (1) physician-diagnosed malnutrition-related International Classification of Diseases, Ninth Revision codes; (2) in-hospital nutritional assessment summaries conducted by registered dietitians; and (3) body mass indexes (BMIs). For patients with multiple admissions, only data from the first hospitalization were included.
Prevalence of malnutrition diagnosis ranged from 8.8% based on BMI to approximately 26% of all cases based on dietitian assessment. κ coefficients between any methods indicated a weak (κ = 0.23, BMI and dietitians; and κ = 0.28, dietitians and physicians)-to-fair strength of agreement (κ = 0.38, BMI and physicians).
Available methods to identify patients with malnutrition in a National Cancer Institute-designated comprehensive cancer center resulted in varied prevalence of malnutrition diagnosis. A universal standard of care for nutrition screening that uses validated tools is needed.
The Joint Commission on the Accreditation of Healthcare Organizations requires nutritional screening of patients within 24 hours of admission. For this purpose, implementation of a validated tool that can be used by various healthcare practitioners, including nurses, needs to be considered.
某些癌症类型的患者普遍存在营养不良问题。目前，尚缺乏营养筛查的通用标准，对于营养不良的指标也没有达成统一的定义和共识，其有效性也存在争议。
本研究旨在通过对国家癌症研究所指定的综合性癌症中心的病历数据进行二次分析，使用三种分类方法来调查营养不良的诊断率。
本研究回顾性分析了 1998 年期间因头颈部、胃肠道或肺癌而住院的 227 例患者的病历资料，使用三种方法评估患者是否存在营养不良：（1）基于国际疾病分类第九版（ICD-9）中与营养不良相关的诊断代码；（2）营养师进行的院内营养评估总结；（3）体重指数（BMI）。对于多次入院的患者，仅纳入首次入院的数据。
基于 BMI 的营养不良诊断率为 8.8%，而基于营养师评估的营养不良诊断率约为 26%。任何两种方法之间的κ系数均显示出较弱至中等程度的一致性（κ=0.23，BMI 和营养师；κ=0.28，营养师和医生）（κ=0.38，BMI 和医生）。
在国家癌症研究所指定的综合性癌症中心，用于识别营养不良患者的方法有多种，其结果导致营养不良的诊断率也各不相同。因此，需要制定一种使用经过验证的工具的通用营养筛查标准。
医疗保健组织联合委员会要求在患者入院后 24 小时内进行营养筛查。为此，需要考虑实施一种经过验证的工具，以便包括护士在内的各种医疗保健从业者都可以使用。
