Screening, identification, and diagnosis of malnutrition in hospitalized patients with solid tumors: A retrospective cohort study.

IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Nutrition in Clinical Practice Pub Date : 2024-12-01 Epub Date: 2024-10-29 DOI:10.1002/ncp.11233
Aynur Aktas, Declan Walsh, Danielle Boselli, Lenna Finch, Michelle L Wallander, Kunal C Kadakia
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Abstract

Background: Malnutrition is common in hospitalized patients with cancer and adversely affects clinical outcomes. We evaluated the prevalence of malnutrition risk, dietitian-identified malnutrition (DIMN), and physician-diagnosed malnutrition (PDMN) at admission.

Methods: This retrospective study included adults diagnosed with a stage I-IV solid tumor malignancy and admitted to Atrium Health Carolinas Medical Center from January 2016 to May 2019. Malnutrition risk was determined by a score ≥2 on the Malnutrition Screening Tool (MST) administered by a registered nurse during the intake process. Registered dietitian nutritionist (RDN) assessments were reviewed for DIMN and grade (mild, moderate, or severe). PDMN included malnutrition International Classification of Diseases, Tenth Revision codes in the discharge summary. Univariate models were estimated; multivariate logistic regression models identified associations between clinicodemographic factors and malnutrition prevalence with stepwise selection.

Results: A total of 5143 patients were included. Median age was 63 (range 18-102) years, 48% were female, 70% were White, and 24% were Black. Upper gastrointestinal (21%), thoracic (18%), and genitourinary (18%) cancers were most common. A total of 28% had stage IV disease. MST scores were available for 4085 (79%); 1005 of 4085 (25%) were at malnutrition risk. Eleven percent (n = 557) had malnutrition coded by a physician or documented by an RDN; 4% (n = 223) of these were identified by both clinicians, 4% (n = 197) by RDNs only, and 3% (n = 137) by physicians only.

Conclusion: Malnutrition appears to be underdiagnosed by both RDNs and physicians. Underdiagnosis of malnutrition may have significant clinical, operational, and financial implications in cancer care.

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住院实体瘤患者营养不良的筛查、识别和诊断:一项回顾性队列研究。
背景:营养不良在住院癌症患者中很常见,并对临床预后产生不利影响。我们评估了入院时营养不良风险、营养师确认的营养不良(DIMN)和医生诊断的营养不良(PDMN)的发生率:这项回顾性研究纳入了2016年1月至2019年5月期间被诊断为I-IV期实体瘤恶性肿瘤并入住Atrium Health Carolinas医疗中心的成年人。营养不良风险由注册护士在入院过程中进行的营养不良筛查工具(MST)评分≥2分确定。对注册营养师 (RDN) 的评估进行审查,以确定 DIMN 和等级(轻度、中度或重度)。PDMN 包括出院摘要中的营养不良国际疾病分类第十版代码。对单变量模型进行了估计;多变量逻辑回归模型通过逐步选择确定了临床人口学因素与营养不良发生率之间的关联:结果:共纳入 5143 名患者。中位年龄为 63 岁(18-102 岁不等),48% 为女性,70% 为白人,24% 为黑人。上消化道癌症(21%)、胸部癌症(18%)和泌尿生殖系统癌症(18%)最为常见。共有 28% 的患者处于 IV 期。4085人(79%)有MST评分;4085人中有1005人(25%)有营养不良风险。11%(n = 557)的营养不良情况由医生编码或由营养营养师记录;其中4%(n = 223)的营养不良情况由两位临床医生共同确认,4%(n = 197)的营养不良情况仅由营养营养营养师确认,3%(n = 137)的营养不良情况仅由医生确认:营养不良似乎被营养营养师和医生诊断不足。营养不良的诊断不足可能会对癌症护理的临床、操作和财务产生重大影响。
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来源期刊
CiteScore
6.00
自引率
9.70%
发文量
128
审稿时长
3 months
期刊介绍: NCP is a peer-reviewed, interdisciplinary publication that publishes articles about the scientific basis and clinical application of nutrition and nutrition support. NCP contains comprehensive reviews, clinical research, case observations, and other types of papers written by experts in the field of nutrition and health care practitioners involved in the delivery of specialized nutrition support. This journal is a member of the Committee on Publication Ethics (COPE).
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