Nutritional screening tools in critical care

Abstract

Nutrition screening tools are rapid, simple, and accurate methods of determining patient nutritional status. They are usually used at first contact with a dietician or another healthcare professional such as a nurse or doctor. A full clinical assessment is not complete without nutritional screening. The use of a nutritional screening tool is usually standardized across a region as recommended by organizations such as the British Association for Parenteral and Enteral Nutrition (BAPEN) or the European Society for Parenteral and Enteral Nutrition (ESPEN). Of course, other organizations in various different countries have also set regional standards of practice. During the development of a nutritional screening tool, the variables that affect nutritional status must be considered. These include dietary, physical, anthropometric, psychological, social, and clinical factors. Nutritional screening tools can also provide a timeline of patient nutritional status, informing past, present, and/or future risk of malnutrition.Depending on the tool used, several variables can be determined; the most simple tools measure protein-energy status.The most commonly used tools in current clinical practice are Subjective Global Assessment (SGA), Malnutrition Screening Tool (MST), Short Nutritional Assessment Questionnaire#(SNAQ#), Nutrition Risk Screening 2002 (NRS 2002), and Malnutrition Universal Screening Tool (MUST). These tools have all been validated for their use and predictive power. Continued successful application of each tool ideally requires revalidation for the intended users in the setting in which it is to be used. There must also be a logistical infrastructure that supports nutritional screening (e.g., measurement tools, documentation, follow-up plans). Finally, each tool requires continual audit and assessment of efficacy.