Nutritional Screening Tool for In-Hospital Patients

Malnutrition is a common problem in hospital settings. A poor nutritional status has been associated with higher rates of infection, poor wound healing, longer hospital stays, and higher hospital costs. Therefore, early recognition and timely treatment of malnutrition is vital. To identify malnourished individuals or those at risk of becoming malnourished, selecting and validated a uniform screening tool is clearly an important issue. Both the Nutritional Risk Screening-2002 (NRS-2002) and Malnutrition Universal Screening Tool (MUST) are recommended by the European Society for Parenteral and Enteral Nutrition (ESPEN) for a hospital setting. For older patients, the Mini Nutritional Assessment (MNA) is the recommended tool. Short Nutrition Assessment Questionnaire (SNAQ) and Malnutrition Screening Tools (MST) are brief and simple screening tools that use self-reported queries of variables that include weight loss and poor appetite. On the other hand, many of those require considerable time and labor to administer and may not be highly applicable to a Korean population. In Korea, most hospitals use a computerized nutritional screening system with a self-developed nutrition screening index. The variables for the tools, which are based on each hospital setting, include the objective data available in the patient's medical records and limited information collected from the nursing admission questionnaire. The application of different tools hampers any comparison of the malnutrition prevalence between different settings and patients groups. In addition, the absence of a widely accepted malnutrition screening tool hinders both effective recognition and the treatment of malnutrition. Therefore, the development of uniform and valid screening tools and effective nutritional support programs for Korean malnourished patients is needed.

Characteristics and Clinical Course of Patients Who Received Enteral or Parenteral Nutrition in Tertiary Referral Hospitals in Korea

PURPOSE: The purposes of this study are to evaluate clinical characteristics of malnourished patients who received nutritional therapy and to compare their clinical courses according to nutritional support team (NST) consultation in tertiary referral hospital in Korea. METHODS: From June 2014 to May 2015, 43,954 admitted patients who were more than 18 years old were retrospectively investigated. Characteristics of patients who received enteral nutrition (EN) or parenteral nutrition (PN) for more than 3 days (nutritional therapy group) were compared to the patients without nutritional therapy (control group). In addition, clinical courses according to NST consultation (NST group and non-NST group) were compared through propensity score matching (PSM). RESULTS: EN or PN was applied in 4,599 patients for more than 3 days (nutritional therapy group: 10.5%). For characteristics, there were significant differences between two groups (nutritional therapy group vs. control group) with age, male proportion, body weight, body mass index. All laboratory data at admission were significantly worse in nutritional therapy group. And for clinical courses, there were significant differences in length of stay (LOS), rate of intensive care unit (ICU) admission, LOS in ICU, Acute Physiology and Chronic Health Enquiry (APACHE II) score, days of nutritional therapy, mortality rate. NST consultation was made in 39% of nutritional therapy group. Among departments, Thoracic Surgery showed the highest rate of NST consultation (68.5%) otherwise Neurosurgery showed the lowest rate (18.7%). When PSM between NST group vs. non-NST group were made, significant differences was shown only in the rate of ICU admission, EN or PN support days, cholesterol at discharge. CONCLUSION: In tertiary referral hospital in Korea, more than 10% of patients still needed active nutritional therapy. NST consultation rate varies among departments. We failed to find significant differences between NST group and non-NST group.