Identifying nutrition risk in emergency patients: What is the most appropriate screening tool?

BACKGROUND: The emergency department (ED) is the most frequent access route to the hospital. Nutrition risk (NR) screening allows the early identification of patients at risk of malnutrition. This study aimed to evaluate the feasibility and predictive validity of five different tools in EDs: Nutritional Risk Screening 2002 (NRS-2002), Nutritional Risk Emergency 2017 (NRE-2017), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), Malnutrition Universal Screening (MUST), and Malnutrition Screening Tool (MST). METHODS: Patients with scores ≥3 according to the NRS-2002, ≥1.5 according to the NRE-2017, and ≥2 according to the MUST, RFH-NPT, or MST were classified with NR. Prolonged length of stay (LOS) and 1-year mortality were evaluated. RESULTS: 431 patients were evaluated (57.31 ± 15.6 years of age; 54.4% women) in a public hospital in southern Brazil. The prevalence of NR was: 35% according to the NRS-2002, 43% according to the MST, 45% according to the NRE-2017 and MUST, and 49% according to the RFH-NPT. Patients with NR, had a greater risk of prolonged LOS (P < 0.001). The presence of NR was associated with an increased risk of 1-year mortality according to the NRS-2002 (hazard ratio [HR]: 4.04; 95% CI, 2.513-6.503), MST (HR: 2.60; 95% CI, 1.701-3.996), NRE-2017 (HR: 4.82; 95% CI, 2.753-8.443), MUST (HR: 4.00; 95% CI, 2.385-6.710), and RFH-NPT (HR: 5.43; 95% CI, 2.984-9.907). CONCLUSIONS: NRE-2017 does not require objective data and presented predictive validity for all outcomes assessed, regardless of the severity of the disease, and thus appears to be the most appropriate tool for carrying out NR screening in the ED.

TRANSLATION AND CROSS-CULTURAL ADAPTATION OF THE ROYAL FREE HOSPITAL-NUTRITIONAL PRIORITIZING TOOL (RFH-NPT).

BACKGROUND: Nutritional screening is defined by American Society for Parenteral and Enteral Nutrition (ASPEN) as a process to identify individuals at risk of malnutrition. Malnutrition is a prevalent condition in cirrhotic patients, and it results in important prognostic implications. Most of the commonly used instruments fail in considering the particularities of cirrhotic patients. The Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is a nutritional screening tool developed and validated to identify malnutrition risk in patients with liver disease. OBJECTIVE: The study's aim was to conduct the transcultural adaptation (translation and adaptation) of RFH-NPT tool to Portuguese (Brazil). METHODS: The process of cultural translation and adaptation followed the Beaton et al. methodology. The process involved the steps of initial translation, synthesis translation, back translation pretest of the final version with 40 nutritionists and a specialists committee. The internal consistency was calculated with the Cronbach coefficient and the content validation was verified with the content validation index. RESULTS: Forty clinical nutritionists with experience in treatment of adult patients participated in the step of cross-cultural adaptation. The alpha Cronbach coefficient was 0.84, which means high reliability. In the specialists analyzes all the tool's questions achieved a validation content index higher than 0.8, showing high agreement. CONCLUSION: The NFH-NPT tool was translated and adapted to Portuguese (Brazil) and showed high reliability.

Adaptação transcultural da ferramenta Royal Free Hospital-Nutritional Prioritizing tool (RFH-NPT) / Translation and cross-cultural adaptation of the royal free hospital-nutritional prioritizing tool (rfh-npt)

ABSTRACT Background: Nutritional screening is defined by American Society for Parenteral and Enteral Nutrition (ASPEN) as a process to identify individuals at risk of malnutrition. Malnutrition is a prevalent condition in cirrhotic patients, and it results in important prognostic implications. Most of the commonly used instruments fail in considering the particularities of cirrhotic patients. The Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is a nutritional screening tool developed and validated to identify malnutrition risk in patients with liver disease. Objective The study's aim was to conduct the transcultural adaptation (translation and adaptation) of RFH-NPT tool to Portuguese (Brazil). Methods: The process of cultural translation and adaptation followed the Beaton et al. methodology. The process involved the steps of initial translation, synthesis translation, back translation pretest of the final version with 40 nutritionists and a specialists committee. The internal consistency was calculated with the Cronbach coefficient and the content validation was verified with the content validation index. Results: Forty clinical nutritionists with experience in treatment of adult patients participated in the step of cross-cultural adaptation. The alpha Cronbach coefficient was 0.84, which means high reliability. In the specialists analyzes all the tool's questions achieved a validation content index higher than 0.8, showing high agreement. Conclusion: The NFH-NPT tool was translated and adapted to Portuguese (Brazil) and showed high reliability.

RESUMO Contexto: A triagem nutricional é definida pela Sociedade Americana de Nutrição Parenteral e Enteral (ASPEN) como um processo para identificar indivíduos em risco de desnutrição. A desnutrição é uma condição prevalente em pacientes cirróticos e resulta em importantes implicações prognósticas. A maioria dos instrumentos comumente utilizados falha em considerar as particularidades dos pacientes com cirrose. A Royal Free Hospital-Nutritional Prioritizing Tool (RFH NPT) é uma ferramenta de triagem nutricional desenvolvida e validada para identificar o risco de desnutrição em pacientes com doença hepática. Objetivo: O objetivo do estudo foi realizar a adaptação transcultural (tradução e adaptação cultural) da ferramenta RFH-NPT para o português (Brasil). Métodos: O processo de tradução e adaptação cultural seguiu a metodologia de Beaton et al. O processo envolveu as etapas de tradução inicial, síntese das traduções, retrotradução, pré-teste da versão final em uma amostra de 40 nutricionistas e comitê de especialistas. A consistência interna foi calculada pelo coeficiente de Cronbach e a validação de conteúdo foi verificada por meio do índice de validação de conteúdo. Resultados: Quarenta nutricionistas clínicos com experiência no tratamento de pacientes adultos participaram da etapa de adaptação cultural. O coeficiente alfa de Cronbach foi de 0,84, que expressa alta confiabilidade. Na análise dos especialistas, todas as questões da ferramenta obtiveram índice de validação de conteúdo superior a 0,8, apresentando alta concordância. Conclusão: A ferramenta RFH-NPT foi traduzida e adaptada para a língua portuguesa do Brasil apresentando alta confiabilidade.