Application of subjective global assessment as a screening tool for malnutrition in pediatric surgical patients.

ABSTRACT

OBJECTIVES: To determine the incidence of malnutrition in the pediatric surgical ward and to evaluate the value of SGA as a nutrition assessment tool in this patient group. PATIENTS AND METHOD: Consecutive pediatric patients aged 2 months-16 years who were admitted for an operation in the pediatric surgical ward, Songklanagarind Hospital from February to September 2001 were included. Nutritional assessment was performed for each case, using a translated version of the SGA questionnaire. Anthropometric measurements and laboratory tests were performed as a routine pre-operative evaluation. The result of the SGA ratings were tested against the other parameters and Gomez's weight for age (W/A) criteria for protein energy malnutrition. SGA and the other parameters were tested for association with post-operative infectious complications. Each SGA question was analyzed by multivariate logistic regression analysis, to determine an independent correlation between the question item and final SGA rating. RESULTS: The study included 78 patients. At least one item of SGA history was positive in 28 cases (35.9%). The SGA rating was class A in 50 cases (64.1%), class B in 17 cases and class C in 11 cases. According to the Gomez classification, 42 cases (53.8%) were considered normal or overweight, whereas 23 cases (29.5%) were in the first degree underweight, 9 cases were in the second degree and 4 cases were in the third degree. Malnutrition by SGA rating correlated significantly with Gomez's second and third degree malnutrition, lower z-score, lower BMI and hypoalbuminemia. Malnutrition by SGA rating and hypoalbuminemia were associated with increased risk of an infectious complication, whereas a significant relation between a complication and anthropometric malnutrition could not be demonstrated. Moreover, SGA malnutrition was significantly associated with a longer post-operative stay. Among 5 items of SGA questions, history of weight change in the recent 2 weeks and increased energy need considered by an underlying disease were found to be independently associated with a final SGA rating of malnutrition. History of weight loss and gastrointestinal symptoms were the 2 most sensitive questions. CONCLUSIONS: SGA is a sensitive and specific nutrition assessment tool useful in a pre-operative pediatric setting. Application of the protocol as a complement of standard anthropometric tool should be considered.