RELIABILITY OF CLINICAL JUDGMENT IN EVALUATION OF THE NUTRITIONAL-STATUS OF SURGICAL PATIENTS

The ability of surgeons to make a reproducible and reliable evaluation of the nutritional status of patients was assessed. Three independent observers assigned 64 patients to one of four nutritional states - normal nourishment, and mild, moderate and severe malnutrition - using a questionnaire and clinical examination. Interobserver variability was analysed using the re statistic and reliability by assessing the correlation between the assigned class and total serum protein, haemoglobin, albumin, transferrin and cholesterol levels, weight loss and the results of immunological skin rests. Concordance was observed in 49 of the 64 judgements (77 per cent) and partial agreement in the remainder (kappa=0.74, P<0.001). Clinical judgement correlated significantly with albumin, transferrin and cholesterol levels and weight loss (R(2)=0.73, P<0.001). Surgeons are able to assess nutritional status using clinical judgement.