Nutrition assessment: the reproducibility of subjective global assessment in patients requiring mechanical ventilation

Abstract

Background/Objective The detection of malnutrition in the intensive care unit (ICU) is critical to appropriately address its contribution on outcomes. The primary objective of this investigation was to determine if nutritional status could be reliably classified using Subjective Global Assessment (SGA) in mechanically ventilated (MV) patients. Subjects/Methods Fifty-seven patients requiring MV greater than 48 hours in a university-affiliated medical ICU were evaluated in this cross-sectional study over a 3 month period. Nutritional status was categorized independently by two Registered Dietitians using SGA. Frequencies, means (± standard deviations), Chi square and T tests were used to describe the population characteristics; agreement between raters was evaluated using the κ statistic. Results On admission, the average patient was 50.4 (± 14.2) years of age, overweight (body mass index: 29.0 ± 9.2), had an APACHE II score of 24 (± 10) and respiratory failure. Fifty percent (n=29) of patients were categorized as malnourished. Agreement between raters was 95% prior to consensus, reflecting near perfect agreement (κ =0.90) and excellent reliability. Patients categorized as malnourished were more often admitted to the hospital floor prior to the ICU (n=32; 56%), reported decreased dietary intake (69% vs. 46%, p=0.02) and exhibited signs of muscle wasting (45% vs. 7%, p<0.001, respectively) and fat loss (52% vs. 7%, p<0.001, respectively) on physical exam when compared to normally nourished individuals. Conclusions SGA can serve as a reliable nutrition assessment technique for detecting malnutrition in patients requiring MV. Its routine use should be incorporated into future studies and clinical practice.

Utilizing multiple methods to classify malnutrition among elderly patients admitted to the medical and surgical intensive care units (ICU)

“…Direct comparisons to other studies are difficult in this particular patient population. Using SGA classifications, previous investigators have shown that 37–50% of the patients admitted to the medical 14,15 and surgical ICU 16 were malnourished. These study populations were younger, often required mechanical ventilation and had higher average APACHE II scores than patients in the current study.…”

Intensive Medical Nutrition Therapy: Methods to Improve Nutrition Provision in the Critical Care Setting

“…SGA was originally developed to predict outcomes in surgery patients, 11,12 is associated with morbidity and mortality in various patient populations, 13-15 and has been shown to be reliable in ICU settings. 16 Patients were ranked as normally nourished, moderately or suspected of being malnourished, or severely malnourished. Tools that used objective markers to assess nutritional status (eg, weight, albumin, transferring, and retinol binding protein) were rejected because these markers become unreliable in the face of critical illness.…”

How to Perform Subjective Global Nutritional Assessment in Children

“…For the past 28 years, SGA has been shown to be a valid and reliable tool for identifying malnourished adults (10,11) and it is used around the world for clinical, epidemiologic, and research purposes in a wide variety of adult populations (12)(13)(14)(15)(16)(17)(18)(19). In contrast with objective measures, SGA has been shown capable of predicting development of nutrition-associated morbidities (20)(21)(22)(23)(24)(25).…”