Bedside Nutrition Assessment Past, Present, and Future: A Review of the Subjective Global Assessment

Bedside nutrition assessment remains an essential skill for the practicing clinician to master as the nutrition status of our patients directly influences clinical outcomes and mortality rates. Dr Charles E. Butterworth Jr's initial report of malnutrition in hospitalized patients, the so-called skeleton in the closet, riveted the medical community. Two other studies in the 1970s published prevalence rates of hospital malnutrition of 48% in adult medical patients and 50% in adult surgical patients. Even more disturbing, 75% of patients at risk for malnutrition on admission had worsening nutrition parameters during their hospitalization. These findings led to a search to find an integrated bedside nutrition assessment tool to identify malnutrition in hospitalized patients. Initially reported in 1982, The Subjective Global Assessment is an integrated tool that utilizes the clinical judgment of a practitioner to identify patients at risk of or with malnutrition. It is a clinically useful tool that can be applied at the bedside by the average practitioner. It is a simple, safe, and inexpensive tool allowing for widespread use by trained clinicians and remains the gold standard for new bedside assessment tools. (Nutr Clin Pract. 2008;23:410-416)