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      Estudio descriptivo de dos herramientas de cribado de riesgo nutricional al ingreso hospitalario en el sanatorio Allende de Argentina Translated title: Descriptive study of two tools for nutritional risk screening at hospital admission in the Allende sanatorium from Argentina

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          Abstract

          RESUMEN Introducción El objetivo de este estudio fue comparar dos herramientas de cribado nutricional, Nutritional Risk Screening 2002 (NRS-2002) y Fase de Filtro Nutricional Analítico (FILNUT), sobre una muestra de pacientes al ingreso hospitalario, analizar la prevalencia de riesgo nutricional, evaluar la concordancia entre ambos y su validez para identificar pacientes en riesgo. Material y Métodos Estudio descriptivo, transversal, donde se evaluaron 271 pacientes admitidos dentro de las primeras 72 horas, con el método NRS-2002 utilizado como gold standard y la herramienta FILNUT. Se utilizó el test de Chi2 para la asociación estadística entre los distintos métodos y la concordancia fue estudiada a través del índice Kappa. La precisión se evaluó mediante sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, y razón de verosimilitud. La validez de los test de cribado nutricional para identificar pacientes en riesgo se analizó mediante la comparación de curvas ROC con cálculo del área bajo la curva (AUC). Resultados La prevalencia de pacientes en riesgo nutricional fue 61% con FILNUT y 31% con NRS-2002. El método FILNUT, con una alta sensibilidad (92,8%), deja un gran número de falso positivos por su baja especificidad (53,3%). La concordancia entre ambos métodos fue aceptable (Kappa=0,37). Mediante la curva ROC, se comprobó que los test de cribado fueron válidos para identificar pacientes en riesgo: FILNUT AUC=0,999 (IC95%: 0,963-0,100); NRS-2002 AUC=0,708 (IC95%: 0,643-0,767). Conclusiones: El método FILNUT es una herramienta de cribado válida que reveló mayor prevalencia de riesgo nutricional y con alta sensibilidad descartó apropiadamente a aquellos pacientes sin riesgo. Al comparar ambas herramientas, FILNUT incorpora el uso de prealbúmina, cuyos bajos valores deberían considerarse como potencial riesgo nutricional. Por otra parte, su escaso factor tiempo y costos directos en su realización, lo avalan como herramienta eficiente. La simplicidad y facilidad requerida para su realización contrastan con el NRS-2002 que requiere de personal capacitado.

          Translated abstract

          ABSTRACT Introduction The aim of this study was to compare two nutritional screening tools, Nutritional Risk Screening 2002 (NRS-2002) and Nutritional Analytical Phase Filter (FILNUT) on a sample of patients to hospital admission, analyze the prevalence of nutritional risk, assess the agreement between the two and their validity for identifying patients at risk. Material and Methods Descriptive, cross-sectional study, where 271 admitted patients were evaluated within the first 72 hours, using the NRS-2002 method used as the gold standard and the FILNUT tool. Chi2 test was used for the statistical association between the different methods and the agreement was analyzed with the Kappa index. Accuracy was assessed by sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio. The validity of the nutritional screening test to identify patients at risk was analyzed by comparing ROC curves with determination of the area under the curve (AUC). Results The prevalence of patients at nutritional risk was 61% with FILNUT and 31% with NRS-2002. The FILNUT method with high sensitivity (92.8%), throws a considerable number of false positives by low specificity (53.3%). The agreement between both tools was fair (Kappa=0.37). Using ROC curve, both tests were valid for identify patients at risk: AUC=0.999 FILNUT (95%IC: 0.963-0.100); NRS-2002 AUC=0.708 (95%IC: 0.643-0.767). Conclusions The FILNUT method is a valid screening tool that reveals higher prevalence of nutritional risk and with high sensitivity to dismiss properly those patients without risk. Comparing both tools, FILNUT incorporates the use of prealbumin, whose low levels should be considered as potential nutritional risk. On the other hand, its low time factor and direct costs in its implementation ensure it as an efficient tool. The simplicity and facility required for its performance contrast with the NRS-2002 that requires trained personnel.

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          Most cited references19

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          Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).

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            Comparison of tools for nutritional assessment and screening at hospital admission: a population study.

            This population study aimed to test the sensitivity and specificity of nutritional risk index (NRI), malnutrition universal screening tool (MUST) and nutritional risk screening tool 2002 (NRS-2002) compared to subjective global assessment (SGA) and to evaluate the association between nutritional risk determined by these screening tools and length of hospital stay (LOS). Patients (n=995) were assessed at hospital admission by four screening tools (SGA, NRI, MUST and NRS-2002). Sensitivity, specificity and predictive values were calculated to evaluate NRI, MUST and NRS-2002 compared to SGA. Multiple logistic regressions, adjusted for age, were used to estimate odds ratios (OR) and confidence interval (CI) for medium and high, compared to low risk in patients hospitalized >11, compared to 1-10 days LOS. The sensitivity was 62%, 61% and 43% and specificity was 93%, 76% and 89% with the NRS-2002, MUST and NRI, respectively. NRS-2002 had higher positive (85%) and negative predictive values (79%) than the MUST (65% and 76%) or NRI (76% and 66%, respectively). Patients who were severely malnourished or at high nutritional risk by SGA (OR 2.4, CI 1.5-3.9), MUST (OR 3.1, CI 2.1-4.7) and NRS-2002 (OR 2.9, CI 1.7-4.9) were significantly more likely to be hospitalized >11 days, compared to 1-10 days, than patients assessed as low risk. NRS-2002 had higher sensitivity and specificity than the MUST and NRI, compared to SGA. There was a significant association between LOS and nutritional status and risk by SGA, NRS-2002, MUST and NRI. Nutritional status and risk can be assessed by SGA, NRS-2002 and MUST in patients at hospital admission.
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              To screen or not to screen for adult malnutrition?

              There is some controversy about whether all adults receiving healthcare should be routinely screened for nutritional problems. (i) A systematic review examined the proposition that malnutrition is under-recognised and under-treated, and that nutritional interventions in malnourished patients, identified through a screening procedure produce clinical benefits (assessed using randomised controlled trials, RCTs). (ii) A systematic review of nutritional screening interventions in populations of malnourished and well-nourished subjects (RCTs and non-RCTs). (i) The prevalence of malnutrition varies according to the criteria used, but is estimated to affect 10-60% of patients in hospital and nursing homes, 10% or more of older free-living subjects, and less than 5% of younger adults. In the absence of formal screening procedures, more than half the patients at risk of malnutrition in various settings do not appear to be recognised and/or are not referred for treatment. RCTs show that nutritional interventions in malnourished patients produce various clinical benefits. (ii) Interventions with nutritional screening in different care settings also generally suggest clinical benefits, but some are limited by small sample sizes and inadequate methodology. Factors that influence outcomes include validity, reliability and ease of using the screening procedure, the 'care gap' that exists between routine and desirable care and the need for other resources, which may increase or decrease following screening. The frequent failure to recognise and treat malnutrition, especially where it is common, is unacceptable. In such circumstances, the routine use of a simple screening procedure is recommended. Each health care setting should have a transparent policy about nutritional screening, which may vary according to the 'care gap', available resources, and specific populations of patients, in which the prevalence of malnutrition may vary widely.
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                Author and article information

                Journal
                renhyd
                Revista Española de Nutrición Humana y Dietética
                Rev Esp Nutr Hum Diet
                Academia Española de Nutrición y Dietética (Pamplona, Navarra, Spain )
                2173-1292
                2174-5145
                March 2020
                : 24
                : 1
                : 20-28
                Affiliations
                [3] Córdoba orgnameSanatorio Allende orgdiv1Servicio de Medicina Interna Argentina
                [2] Córdoba orgnameSanatorio Allende orgdiv1Servicio de Nutrición Argentina
                [1] Córdoba orgnameSanatorio Allende orgdiv1Unidad de Soporte Metabólico y Nutricional Argentina
                Article
                S2174-51452020000100003 S2174-5145(20)02400100003
                10.14306/renhyd.24.1.752
                27df1a3d-6d8c-4998-a942-13aee6141a55

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 25 January 2020
                : 08 February 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 9
                Product

                SciELO Spain

                Categories
                Investigaciones

                Cribado nutricional,Nutritional screening,Malnutrition,Hospitales,Diagnóstico,FILNUT,Desnutrición,Desnutrición hospitalaria,Diagnosis,NRS-2002,Hospital malnutrition,Hospitals

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