Development of a Nutrition Screening Tool for an Outpatient Wound Center

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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.


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


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


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.


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


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


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.


An outpatient wound center in Northeast Ohio.


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


Malnutrition as assessed by the Scored PG-SGA.


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%).


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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