Refeeding Syndrome Diagnostic Challenges and the Potential of Clinical Decision Support Systems

Background: Refeeding syndrome (RFS) can occur in malnourished patients when normal, enteral, or parenteral feeding is resumed. The syndrome often goes unrecognized and may, in the most severe cases, result in death. The diagnosis of RFS can be crucially facilitated by the use of clinical decision support systems (CDSS). Methods: The literature in PubMed was searched for current treatment recommendations, randomized intervention studies, and publications on RFS and CDSS. We also took account of insights gained from the development and implementation of our own CDSS for the diagnosis of RFS. Results: The identification of high-risk patients and the recognition of manifest RFS is clinically challenging due to the syndrome's unspecific symptoms and physicians' lack of awareness of the risk of this condition. The literature shows that compared to patients without RFS, malnourished patients with RFS have significantly greater 6-month mortality (odds ratio 1.54, 95% confidence interval: [1.04; 2.28]) and an elevated risk of admis-sion to intensive care (odds ratio 2.71 [1.01; 7.27]). In a prospective testing program, use of our own CDSS led to correct diagnosis in two thirds of cases. Conclusion: RFS is difficult to detect and represents a high risk to the patients affected. Appropriate CDSS can identify such patients and ensure proper professional care.

Automated summary

This study investigates the role of clinical decision support systems (CDSS) in the diagnosis of refeeding syndrome (RFS) and highlights the importance of identifying high-risk patients. The literature review reveals that malnourished patients with RFS have higher mortality rates and an increased risk of ICU admission compared to those without RFS. The use of CDSS significantly improves the detection and diagnosis of RFS.