National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.
Eur J Clin Nutr. 2012 Mar;66(3):382-7. doi: 10.1038/ejcn.2011.209. Epub 2011 Dec 14.
BACKGROUND/OBJECTIVES: A disease-specific nutrition screening tool (NST): the spinal nutrition screening tool (SNST) has been developed for use in patients with spinal cord injury (SCI) but its reliability and agreement with other published tools requires investigation. The aims of this study were to assess the prevalence of malnutrition risk in SCI patients and to confirm the diagnostic accuracy of the SNST.
SUBJECTS/METHODS: Patients' baseline clinical data, anthropometric measurements and NST scores were assessed. The validity of the SNST was assessed by (i) comparing with a full dietetic assessment (criterion validity); (ii) comparison with a generic NST: malnutrition universal screening tool (MUST) (concurrent validity); and (iii) completion of an additional SNST to assess inter- and intra-rater reliability. Agreement was assessed using Cohen's κ-statistics.
Using the SNST, the prevalence of malnutrition risk ranged from 22 to 64% on admission to four SCI centres. The SNST had substantial agreement with MUST (κ: 0.723, 95% confidence interval (CI): 0.607-0.839) and dietitian assessment (κ: 0.567, 95% CI: 0.434-0.699). The SNST had a moderate to substantial reliability (inter-rater reliability: κ: 0.5, 95% CI: 0.2-0.8; intra-rater reliability: κ: 0.64, 95% CI: 0.486-0.802). When compared with dietetic assessment, the SNST had a numerically lower specificity (76.1% vs 80.4%) and similar agreement to MUST (κ: 0.57 vs 0.58) but SNST showed a numerically higher sensitivity (85.7% vs 80.4%) and a numerically higher negative predictive value (92% vs 89.2%) than MUST.
This study shows that malnutrition is common in SCI patients. The SNST is an acceptable (valid and reliable) NST and may be a useful alternative to MUST in identifying SCI patients at risk of malnutrition.
背景/目的：一种特定于疾病的营养筛查工具（NST）：脊柱营养筛查工具（SNST）已被开发用于脊髓损伤（SCI）患者，但需要对其可靠性和与其他已发表工具的一致性进行研究。本研究的目的是评估 SCI 患者的营养不良风险发生率，并确认 SNST 的诊断准确性。
受试者/方法：评估患者的基线临床数据、人体测量学测量和 NST 评分。通过以下方式评估 SNST 的有效性：（i）与全面饮食评估进行比较（标准有效性）；（ii）与通用 NST：营养不良通用筛查工具（MUST）进行比较（同期有效性）；和（iii）完成额外的 SNST 以评估内部和内部评分者的可靠性。使用 Cohen's κ 统计量评估一致性。
使用 SNST，4 个 SCI 中心入院时营养不良风险的发生率范围为 22%至 64%。SNST 与 MUST 具有实质性一致性（κ：0.723，95%置信区间（CI）：0.607-0.839）和营养师评估（κ：0.567，95%CI：0.434-0.699）。SNST 具有中度至高度可靠性（内部评分者可靠性：κ：0.5，95%CI：0.2-0.8；内部评分者可靠性：κ：0.64，95%CI：0.486-0.802）。与饮食评估相比，SNST 的特异性略低（76.1% vs 80.4%），与 MUST 的一致性相同（κ：0.57 vs 0.58），但 SNST 的敏感性略高（85.7% vs 80.4%），阴性预测值略高（92% vs 89.2%）比 MUST。
本研究表明，营养不良在 SCI 患者中很常见。SNST 是一种可接受的（有效且可靠）NST，可能是 MUST 的一种有用替代方法，可用于识别有营养不良风险的 SCI 患者。
