The Association Between Screening Tools Used to Assess Nutrition Status in an Acute Care Setting

ABSTRACT

Background: Screening tools to assess both the risk of malnutrition (such as the Malnutrition Screening Tool, MST) and wound development (Braden scale) are frequently utilized in the hospital setting. Hospital-acquired pressure injuries (HAPIs) result in considerable patient harm, including expensive treatments, increased length of stays, and increased mortality. Malnutrition is a significant risk factor in the development and progression of HAPIs. Therefore, identifying malnutrition risk and prevalence is an important step in preventing HAPIs. However, processes which involve multiple screening steps consume resources such as staff and time which have become scarce during the COVID-19 pandemic. While the Braden scale contains a nutrition component as a sub-score, little is known about the validity of this sub-scale to capture malnutrition risk. We aimed to explore the association between a validated malnutrition screening tool (MST) and the Braden nutrition scale to determine their use in generating nutrition consults. Methods: We conducted a retrospective chart review of adult patients who developed a HAPI during hospital admission. Baseline MST scores (0-6) and Braden nutrition sub-scale score (1-4) were collected. Higher MST scores represent increased risk of malnutrition, while lower Braden nutrition sub-scores represent poor nutrition status. Documentation of a malnutrition diagnosis using the ASPEN guidelines (yes/no) was also collected for each patient. Pearson correlation coefficients and linear regression were used to assess the association between the MST and Braden nutrition sub-score in the entire cohort. A sub-analysis was conducted in the patients with a diagnosis of malnutrition. Logistic regression was performed to evaluate the association between the Braden nutrition sub-scores and a malnutrition diagnosis. Results: The cohort included 133 patients with a mean age of 69.3 years, with 69.9% being male. 77 patients had malnutrition status recorded, with 64.9% diagnosed with malnutrition. There was a significant correlation between Braden nutrition sub-score and MST (R = -0.28;p < 0.001) in the overall cohort and in subjects with malnutrition (R = -0.35;p = 0.01). Linear regression confirmed that low Braden scale nutrition subscores (poor nutrition status) were predicted by high MST scores (risk for malnutrition) (p = < 0.001). Logistic regression modeling showed a higher Braden nutrition sub-score (better nutrition status) was associated with a diagnosis of malnutrition (OR 0.45;p=0.057). Conclusion: The results of this study demonstrate that the MST and the Braden nutrition sub-scores are correlated in a cohort of hospitalized patients who developed a HAPI. Use of both screening tools may not be necessary for identifying those that warrant further assessment and interventions for malnutrition.