Identifying malnutrition risk in acute medical patients: Validity and utility of Malnutrition Universal Screening Tool and Modified Malnutrition Screening Tool

Abstract

Aim: Nutrition screening is increasingly conducted in hospitals during the patient admission process. We aimed to explore the ease of use of two tools in the conduct of screening by nutrition technicians (NTs), and to compare validity. The tools are Malnutrition Universal Screening Tool (MUST) and Modified Malnutrition Screening Tool (Mod‐MST). Methods: A sample of 262 consecutive adult hospital patients in medical wards was screened during December 2008 to January 2009. Trained NTs used both tools to screen each patient. Dietitians who were blinded to screening results then assessed each patient using Subjective Global Assessment as a reference tool. Time taken for screening was recorded and ease of tool use was explored in interviews with technicians. Results: The specificity of MUST and Mod‐MST was 85% and 83%, respectively, with sensitivity of 80% and 77%. Both tools were easy to use and could be applied to all patients, including those unable to answer interview questions. However, the MUST took two to three times longer to complete (5–7 min) using objective data. The Mod‐MST collected subjective data that required interpretation by technicians. Conclusion: Specificity and sensitivity of the two tools were less than optimum at ≤85%, as some patients would be misclassified. Both tools were valid and feasible to use with all medical patients, including those with whom communication cannot be established. The Mod‐MST is recommended, as choice of malnutrition screening tool needs to balance efficacy with time taken to be useful for mass screening programs.

The Indigenous Australian Malnutrition Project: the burden and impact of malnutrition in Aboriginal Australian and Torres Strait Islander hospital inpatients, and validation of a malnutrition screening tool for use in hospitals—study rationale and protocol

“…The study outlined in this paper aims to provide a new and detailed perspective on the burden, impact and diagnosis of PEM in a high income country setting and in an underserved population, in this instance, Indigenous Australians. The prevalence of PEM and those at-risk of malnutrition is significant in hospital inpatients (Allard et al 2015 ; Agarwal et al 2012 , 2013 ; Ultang et al 2012 ; Gibson et al 2012 ). PEM, in turn, has been associated with a number of adverse clinical outcomes (Allard et al 2015 ; Agarwal et al 2012 , 2013 ; Escott-Stump 2012 ; Lim et al 2012 ; Rowell and Jackson 2011 ; Saunder et al 2010 ).…”

“…Rates of hospital inpatient PEM vary greatly between surveys depending on the patient population and the methods used to diagnose malnutrition. In recent hospital-based surveys in Canada and Australia, using the Subjective Global Assessment (SGA), the prevalence of PEM in adult inpatients has been reported as ranging from 17 to 58 % (Allard et al 2015 ; Ultang et al 2012 ; Gibson et al 2012 ). Compared to well-nourished patients, surveys also demonstrated that malnourished patients had an increased length of hospital stay, higher rates of in-hospital mortality, more frequent hospital readmissions, and overall poorer longer-term survival rates (Allard et al 2015 ; Agarwal et al 2013 ; Lim et al 2012 ; Norman et al 2008 ; National Collaborating Centre for Acute Care [NICE] 2006 ).…”

“…medical, surgical, and oncology inpatients) (van Bokhorst-de van der Schueren et al 2014 ), the MST has not been validated for the Indigenous Australian population. The MST poses potential cultural and linguistic barriers that may potentially influence the reliability and validity of the tool (Shaw et al 2015 ; Gibson et al 2012 ; Clifford et al 2010 ; Frew et al 2010 ). These include patients needing to understand, and being able to recall, questions relating to changes in appetite and/or weight loss in the last 6 months (Fang et al 2013 ; Ferguson et al 1999 ).…”

Rekindling the role of nurses in patients' oral nutrition

“…The standards defined nutritional care by identifying the following processes. First, all patients are screened by the nursing staff using the Malnutrition Screening Tool, and those at risk are referred to the dietitian for further assessment and the development of a nutritional care plan in consultation with nurses . Nutritional screening by nursing staff is a requirement under Australian hospital standards .…”

“…First, all patients are screened by the nursing staff using the Malnutrition Screening Tool, and those at risk are referred to the dietitian for further assessment and the development of a nutritional care plan in consultation with nurses. [19][20][21][22][23] Nutritional screening by nursing staff is a requirement under Australian hospital standards. 24 Second, adequate staffing for mealtimes is ensured by nurses not taking breaks during this time and encouraging volunteers and family members to assist with this aspect of care.…”