J Acad Nutr Diet. 2018 May;118(5):896-903. doi: 10.1016/j.jand.2017.10.010. Epub 2018 Feb 21.
Undernourished patients discharged from the hospital require follow-up; however, attendance at return visits is low. Teleconsultations may allow remote follow-up of undernourished patients; however, no valid method to remotely perform physical examination, a critical component of assessing nutritional status, exists.
This study aims to compare agreement between photographs taken by trained dietitians and in-person physical examinations conducted by trained dietitians to rate the overall physical examination section of the scored Patient Generated Subjective Global Assessment (PG-SGA).
Nested cross-sectional study.
PARTICIPANTS/SETTING: Adults aged ≥60 years, admitted to the general medicine unit at Flinders Medical Centre between March 2015 and March 2016, were eligible. All components of the PG-SGA and photographs of muscle and fat sites were collected from 192 participants either in the hospital or at their place of residence after discharge.
Validity of photograph-based physical examination was determined by collecting photographic and PG-SGA data from each participant at one encounter by trained dietitians. A dietitian blinded to data collection later assessed de-identified photographs on a computer.
Percentage agreement, weighted kappa agreement, sensitivity, and specificity between the photographs and in-person physical examinations were calculated. All data collected were included in the analysis.
Overall, the photograph-based physical examination rating achieved a percentage agreement of 75.8% against the in-person assessment, with a weighted kappa agreement of 0.526 (95% CI: 0.416, 0.637; P<0.05) and a sensitivity-specificity pair of 66.9% (95% CI: 57.8%, 75.0%) and 92.4% (95% CI: 82.5%, 97.2%).
Photograph-based physical examination by trained dietitians achieved a nearly acceptable percentage agreement, moderate weighted kappa, and fair sensitivity-specificity pair. Methodological refinement before field testing with other personnel may improve the agreement and accuracy of photograph-based physical examination.
从医院出院的营养不良患者需要随访，但就诊率低。远程会诊可能允许对营养不良患者进行远程随访；然而，目前还没有有效的方法可以远程进行体检，而体检是评估营养状况的关键组成部分。
本研究旨在比较经过培训的营养师拍摄的照片和经过培训的营养师进行的亲自体检在评估评分患者主观整体评估（PG-SGA）的整体体检部分方面的一致性。
嵌套的横断面研究。
参与者/设置：2015 年 3 月至 2016 年 3 月期间，年龄≥60 岁，入住弗林德斯医疗中心综合医学病房的成年人符合条件。从 192 名参与者中收集 PG-SGA 的所有部分以及肌肉和脂肪部位的照片，这些参与者是在医院或出院后在其居住地收集的。
通过培训的营养师在一次就诊中从每位参与者收集照片和 PG-SGA 数据来确定基于照片的体检的有效性。一位对数据收集不知情的营养师后来在计算机上评估了匿名照片。
计算照片和亲自体检之间的百分比一致性、加权 kappa 一致性、敏感性和特异性。分析中包括所有收集的数据。
总体而言，基于照片的体检评分与亲自评估的百分比一致性为 75.8%，加权 kappa 一致性为 0.526（95%置信区间：0.416，0.637；P<0.05），敏感性特异性对为 66.9%（95%置信区间：57.8%，75.0%）和 92.4%（95%置信区间：82.5%，97.2%）。
经过培训的营养师进行的基于照片的体检达到了几乎可接受的百分比一致性、中度加权 kappa 和适度的敏感性特异性对。在与其他人员进行现场测试之前进行方法学改进可能会提高基于照片的体检的一致性和准确性。
