Department of Dietetics and Speech & Language Therapy.
University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Curr Opin Clin Nutr Metab Care. 2018 May;21(3):184-194. doi: 10.1097/MCO.0000000000000464.
The development of nutritional screening tools has done much to raise the profile of nutrition and encourage healthcare practitioners to consider how to identify children at nutritional risk. However, the next challenge is to ensure nutritional screening accurately identifies those who have immediate and ongoing risk and therefore the potential to impact on it.
In this article, we review recent evidence which suggests that the large-scale use of these tools outside of a research setting is not always helpful. Most are highly sensitive but not particularly specific and therefore cases may be 'overdiagnosed' but also missed. It may therefore be time for nutritional screening to evolve into a process which is able to better consider the cause of risk and requirements for nutrition support with referral criteria, defined goals and outcome measures and exit criteria using a 'measure, plot, think, act' approach embedded into physician rounds. Key challenges relate to improving compliance around nutritional screening within the hospital setting and comparison of nutrition risk between centres, as well as an understanding of the barriers which prevent nutritional screening and assessment from occurring.
It remains to be elucidated as to whether returning to a process which embeds nutritional assessment within the medical review rather than relying on a 'nutrition score' from a screening tool is a more effective way in which to identifying those patients that are malnourished or at risk of malnutrition during their hospital stay.
营养筛查工具的发展极大地提高了营养的关注度，并鼓励医疗保健从业者考虑如何识别有营养风险的儿童。然而，下一个挑战是确保营养筛查准确识别出那些有即时和持续风险的人，因此有潜力对其产生影响。
本文综述了最近的证据，表明这些工具在研究环境之外的大规模使用并不总是有帮助。大多数工具的灵敏度很高，但特异性不高，因此可能会“过度诊断”病例，但也可能会漏诊。因此，营养筛查可能需要发展成为一个能够更好地考虑风险原因和营养支持需求的过程，使用“测量、绘图、思考、行动”的方法，将转诊标准、明确的目标和结果测量以及退出标准嵌入到医生查房中。关键挑战涉及提高医院环境中营养筛查的依从性以及中心之间的营养风险比较，以及了解阻碍营养筛查和评估的障碍。
在医院住院期间，确定将营养评估嵌入医疗评估中而不是依赖筛查工具的“营养评分”是否是识别营养不良或有营养不良风险的患者的更有效方法，这一点仍有待阐明。
