Development of a Nutrition Screening Tool for an Outpatient Wound Center

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Abstract

PURPOSE:

To provide information on the development of a nutrition screening tool using variables believed to be predictive of malnutrition risk in the wound patient population.

TARGET AUDIENCE:

This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

OBJECTIVES:

After participating in this educational activity, the participant should be better able to:

OBJECTIVES:

1. Outline the variables present in patients with wounds taken into consideration when the MEAL tool was developed. 2. Identify the results of the MEAL tool pilot study.

OBJECTIVES:

3. List implications from this study for wound care practice.

OBJECTIVE:

To construct a quickly and easily administered nutrition screening tool using variables believed to be predictive of malnutrition risk in the wound patient population.

DESIGN:

A prospective pilot study assessed patients on a list of suspected variables, as well as the Scored Patient-Generated Subjective Global Assessment (PG-SGA), chosen as the criterion standard. Variables were analyzed to select the most appropriate items for inclusion on a new nutrition screening tool using preliminary bivariate correlations and χ2 tests of association. Items significantly associated with malnutrition were dichotomized, and binary logistic regression analyses were performed to arrive at a final model. A sum score was computed, and receiver operating characteristic analysis was used to determine designation of risk.

SETTING:

An outpatient wound center in Northeast Ohio.

PARTICIPANTS:

The pilot study included a convenience sample of 105 outpatients with at least 1 active wound.

MAIN OUTCOME MEASURES:

Malnutrition as assessed by the Scored PG-SGA.

MAIN RESULTS:

The final nutrition screening tool, the MEAL Scale, is composed of 4 dichotomous elements: multiple wounds (number of wounds), eats less than 3 meals per day, appetite decrease (eats less than usual), and level of activity. These variables predicted 83.7% of the malnutrition cases assessed by the Scored PG-SGA. The receiver operating characteristic analysis showed an acceptable area under the curve (0.8581), and a cutoff score of 2 or greater was selected to indicate risk (median sensitivity = 91.4%, median specificity = 60.9%).

CONCLUSIONS:

Although further studies of validity and reliability are necessary to establish the tool before widespread use, the MEAL Scale is a needed step toward nutrition screening in a wound patient population.

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