Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, Noord-Holland, The Netherlands.
Am J Surg. 2012 Jun;203(6):700-7. doi: 10.1016/j.amjsurg.2011.06.053. Epub 2012 Feb 23.
Preoperative screening for malnutrition has become mandatory in The Netherlands. A sensitive method to diagnose malnutrition would save time and improve effectiveness.
A prospective cross-sectional study of 488 adult elective preoperative outpatients was performed. The accuracy of self-reported height and weight was compared with measured data and 3 commonly used malnutrition screening tools. Interobserver agreement was calculated by the intraclass correlation coefficient, studied in Bland and Altman plots, and analyzed by using Cohen's κ statistic. Accuracy was expressed in sensitivity, specificity, and false-negative rates.
Differences between self-reported and measured data were significant, but clinically irrelevant, because only 1 patient was falsely identified as well nourished. Intraclass correlation coefficient for height, weight, and body mass index was high (.97-.99). Bland-Altman plots showed that the mean ± standard deviation differences and 95% limits of agreement between both methods were as follows: height, .0096 m (±.0262, -.0417 to +.0609 m); weight, -1.28 kg (±2.29, -5.76 to +3.20 kg); body mass index, -.72 kg/m(2) (±1.11, -2.92 to +1.46 kg/m(2)). The κ coefficient was .84 (95% confidence interval, .75-.94). Sensitivity was .97 and specificity was .98. Sensitivity and false-negative rates of self-reported data were better overall compared with the screening tools.
Self-reported data provide highly sensitive information to diagnose malnutrition in preoperative outpatients.
在荷兰，术前筛查营养不良已成为强制性要求。一种敏感的营养不良诊断方法将节省时间并提高效率。
对 488 名成年择期术前门诊患者进行了前瞻性横断面研究。将自我报告的身高和体重与实测数据以及 3 种常用的营养不良筛查工具进行了比较。通过组内相关系数（intraclass correlation coefficient）计算观察者间的一致性，并在 Bland 和 Altman 图中进行研究，然后使用 Cohen's κ 统计量进行分析。准确性用灵敏度、特异性和假阴性率表示。
自我报告数据与实测数据之间存在差异，但临床意义不大，因为只有 1 例患者被错误地识别为营养良好。身高、体重和体重指数的组内相关系数均较高（.97-.99）。Bland-Altman 图显示两种方法之间的平均±标准偏差差异和 95%一致性界限如下：身高，.0096 m（±.0262，-.0417 至 +.0609 m）；体重，-1.28 kg（±2.29，-5.76 至 +3.20 kg）；体重指数，-.72 kg/m(2)（±1.11，-2.92 至 +1.46 kg/m(2)）。κ 系数为.84（95%置信区间，.75-.94）。自我报告数据的灵敏度为 0.97，特异性为 0.98。与筛查工具相比，自我报告数据的灵敏度和假阴性率总体上更好。
自我报告数据可提供高度敏感的信息，用于诊断术前门诊患者的营养不良。
