Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study

Background/Objectives: The prevalence of malnutrition in hospitals is high. No nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate nutritional risk in hospitalized patients using four nutritional screening tools. Subjects/Methods: Four nutritional screening tools were evaluated: nutritional risk screening (NRS-2002), the malnutrition universal screening tool (MUST), the subjective global assessment (SGA) and the mini nutritional assessment (MNA). Patients were assessed within the first 36 h after hospital admission. Date of admission, diagnosis, complications and date of discharge were collected. To compare the tools, the results were reorganized into: patients at risk and patients with a good nutritional status. The statistical analysis included the chi(2)-test to assess differences between the tests and the kappa statistic to assess agreement between the tests. Results: The study sample comprised 400 patients (159 women, 241 men), mean age 67.3 (16.1) years. The prevalence of patients at nutritional risk with the NRS-2002, MUST, SGA and MNA was 34.5, 31.5, 35.3 and 58.5%, respectively. Statistically significant differences were observed between the four nutritional screening tools (P<0.001). The agreement between the tools was quite good except for the MNA (MNA-SGA kappa = 0.491, NRS-2002-SGA kappa = 0.620 and MUST-SGA kappa = 0.635). Patients at nutritional risk developed more complications during admission and had an increased length of stay. Conclusions: The prevalence of nutritional risk in hospitalized patients was high with all the tools used. The best agreement between the tools was for NRS-2002 with SGA and MUST with SGA. At admission, NRS-2002 and MUST should be used to screen for nutritional status. European Journal of Clinical Nutrition (2011) 65, 269-274; doi:10.1038/ejcn.2010.243; published online 17 November 2010