Detsky A S, Mendelson R A, Baker J P, Jeejeebhoy K N
JPEN J Parenter Enteral Nutr. 1984 May-Jun;8(3):245-53. doi: 10.1177/0148607184008003245.
We used decision analysis to compare three strategies for reducing the incidence of nutrition-associated complications in patients undergoing gastrointestinal surgery: treat all patients with nutritional support, treat no patients, or perform a test which categorizes patients as high or low risk (treating only the high risk patients). We use the model to make management recommendations based on current knowledge and to set priorities for future research. The "test strategy" is optimal in the majority of cases which we believe are clinically encountered when the test involves subjective global assessment of nutritional status on admission (sensitivity 0.82, specificity 0.72) and nutritional support must be delivered by a central venous catheter. However, the result is particularly sensitive to the predictive properties associated with the test and is less sensitive to the effectiveness rate of nutritional support in reducing the incidence of postoperative complications. We conclude that in future research priority should be given to studying and improving the predictive properties of nutritional assessment techniques.
我们采用决策分析方法，比较了三种降低胃肠手术患者营养相关并发症发生率的策略：对所有患者进行营养支持治疗、不对任何患者进行治疗、或进行一项将患者分为高风险或低风险的检测（仅治疗高风险患者）。我们使用该模型根据现有知识提出管理建议，并为未来研究确定优先事项。当检测涉及入院时营养状况的主观全面评估（敏感性0.82，特异性0.72）且营养支持必须通过中心静脉导管进行时，我们认为在大多数临床遇到的病例中，“检测策略”是最佳的。然而，结果对与检测相关的预测特性特别敏感，而对营养支持降低术后并发症发生率的有效率不太敏感。我们得出结论，在未来研究中，应优先研究和改善营养评估技术的预测特性。
