Nutritional assessment: comparison of clinical assessment and objective variables for the prediction of length of hospital stay and readmission

被引：113

作者：

Jeejeebhoy, Khursheed N. ^{[1
]}

Keller, Heather ^{[2
]}

Gramlich, Leah ^{[3
]}

Allard, Johane P. ^{[4
]}

Laporte, Manon ^{[5
]}

Duerksen, Donald R. ^{[6
]}

Payette, Helene ^{[7
]}

Bernier, Paule ^{[8
]}

Vesnaver, Elisabeth ^{[9
]}

Davidson, Bridget ^{[10
]}

Teterina, Anastasia ^{[11
]}

Lou, Wendy ^{[12
]}

机构：

[1] Univ Toronto, St Michaels Hosp, Dept Med, Toronto, ON, Canada

[2] Univ Waterloo, Schlegel UW Res Inst Aging, Appl Hlth Sci, Waterloo, ON N2L 3G1, Canada

[3] Univ Alberta, Dept Med, Alberta Hlth Serv, Edmonton, AB, Canada

[4] Univ Toronto, Dept Med, Univ Hlth Network, Toronto, ON, Canada

[5] Campbellton Reg Hosp, Vitalite Hlth Network, Dept Clin Nutr, New Brunswick, NJ USA

[6] Univ Manitoba, Dept Med, St Boniface Hosp, Winnipeg, MB, Canada

[7] Univ Sherbrooke, Fac Med & Hlth Sci, Sherbrooke, PQ J1K 2R1, Canada

[8] Univ Montreal, Jewish Gen Hosp, Montreal, PQ, Canada

[9] Univ Guelph, Dept Family Relat & Appl Nutr, Guelph, ON N1G 2W1, Canada

[10] Canadian Nutr Soc, Toronto, ON, Canada

[11] Univ Hlth Network, Toronto, ON, Canada

[12] Univ Toronto, Dalla Lane Sch Publ Hlth, Toronto, ON, Canada

来源：

AMERICAN JOURNAL OF CLINICAL NUTRITION | 2015年 / 101卷 / 05期

关键词：

length of stay; malnutrition; nutritional assessment; readmission rate; subjective global assessment; SUBJECTIVE GLOBAL ASSESSMENT; TOTAL PARENTERAL-NUTRITION; 3-MONTH INTERVENTION; MUSCLE FUNCTION; SCREENING TOOL; MALNUTRITION; RISK; PREVALENCE; VALIDATION; DISEASE;

D O I：

10.3945/ajcn.114.098665

中图分类号：

R15 [营养卫生、食品卫生]; TS201 [基础科学];

学科分类号：

100403 [营养与食品卫生学];

摘要：

Background: Nutritional assessment commonly includes multiple nutrition indicators (NIs). To promote efficiency, a minimum set is needed for the diagnosis of malnutrition in the acute care setting. Objective: The objective was to compare the ability of different NIs to predict outcomes of length of hospital stay and readmission to refine the detection of malnutrition in acute care. Design: This was a prospective cohort study of 1022 patients recruited from 18 acute care hospitals (academic and community), from 8 provinces across Canada, between 1 July 2010 and 28 February 2013. Participants were patients aged >= 18 y admitted to medical and surgical wards. NIs measured at admission were subjective global assessment (SGA; SGA A = well nourished, SGA B mild or moderate malnutrition, and SGA C = severe malnutrition), Nutrition Risk Screening (2002), body weight, midarm and calf circumference, serum albumin, handgrip strength (HGS), and patient-self assessment of food intake. Logistic regression determined the independent effect of NIs on the outcomes of length of hospital stay (<7 d and >= 7d) and readmission within 30 d after discharge. Results: In total, 733 patients had complete NI data and were available for analysis. After we controlled for age, sex, and diagnosis, only SGA C (OR: 2.19; 95% CI: 1.28, 3.75), HGS (OR: 0.98; 95% CI: 0.96, 0.99 per kg of increase), and reduced food intake during the first week of hospitalization (OR: 1.51; 95% CI: 1.08, 2.11) were independent predictors of length of stay. SGA C (OR: 2.12; 95% CI: 1.24, 3.93) and HGS (OR: 0.96; 95% CI: 0.94, 0.98) but not food intake were independent predictors of 30-d readmission. Conclusions: SGA, HGS, and food intake were independent predictors of outcomes for malnutrition. Because food intake in this study was judged days after admission and HGS has a wide range of normal values, SGA is the single best predictor and should be advocated as the primary measure for diagnosis of malnutrition.

引用

页码：956 / 965

页数：10

共 37 条

[1]

[Anonymous], 1950, BIOL HUMAN STARVATIO

[2]

NUTRITIONAL ASSESSMENT - A COMPARISON OF CLINICAL JUDGMENT AND OBJECTIVE MEASUREMENTS [J].