Background: Data on the prevalence of malnutrition in paediatric patients with spinal cord injury (SCI) are limited. The present study aimed to establish the risk of (i) under-nutrition by using the Screening Tool for Assessment of Malnutrition in Paediatrics: STAMP (score X2) and (ii) over-nutrition by body mass index (BMI) centile (X91st: overweight; X98th: obese). Methods: After obtaining informed consent, a standardized questionnaire was used to collect baseline demographic data and nutrition risk score; BMI was measured and routine blood biochemistry was reviewed in every child (46 months and o18 years) admitted to the SCI centre. Results: Sixty-two children (mean age, 11.4 years; s.d., 4.9; median, 13 years; interquartile range, 7.8-15.6, 39.4% female) with SCI (46.5% tetraplegia, 53.4% complete SCI) were assessed. Prevalence of over-nutrition was high (BMI centile X91st, 41.1%; X98th, 25.5%). Under-nutrition risk was 47.1% (STAMP X2). Only 60% of these 'at risk' patients were referred for further nutritional assessment. Associated phenomena included previous intensive care (55.6 versus 20.8%, Po0.05), mechanical ventilation (58.3 versus 18.2%, Po0.01) and past need for artificial nutrition support (75 versus 12.8%, Po0.01). Conclusions: Both over-and under-nutrition appear common in children with SCI. Our data indicate, furthermore, that children at nutritional risk are under-managed. Future research is needed to complete the validation of the screening tools and to determine how effective intervention can be ensured.
BACKGROUND Alcoholic Liver Disease (ALD) is a spectrum of disorders ranging from simple steatosis to steatohepatitis and cirrhosis. Various non-invasive markers have been validated as reliable prognostic markers of fibrosis in Chronic Viral Hepatitis and Non-Alcoholic Fatty Liver Disease but their utility in ALD is least evaluated. This study aims to compare the fibrosis scores in ALD patients with non-alcoholic healthy controls. METHODS The non-invasive scores of fibrosis namely AST/ALT ratio, BARD score, APRI and FIB-4 were calculated in 30 ALD cases and 30 age matched controls. Alcohol drinking pattern was evaluated using the AUDIT questionnaire. The difference in the fibrosis scores between cases and controls were calculated using independent student's t test. All statistical analysis were done using SPSS software v 20.0 and p value <0.05 was considered statistically significant. RESULTS All the non-invasive scores of fibrosis viz. AST/ALT ratio, BARD score, APRI and FIB-4 were significantly high in ALD cases compared to controls. All the cases had AST/ALT ratio more than >1, 76% of them had BARD score >2, 97% had APRI score >1 and 73% had FIB-4 score >3.25 denoting the presence of significant fibrosis in ALD patients. AUDIT score correlates with all the non-invasive fibrosis scores except AST/ALT ratio. There is significant correlation between FIB-4 score and APRI score (r= 0.962, p=<0.001) and between FIB-4 score and AST/ALT ratio (r= 0.500 p= 0.005). CONCLUSIONS The non-invasive fibrosis markers are significantly high in ALD cases. APRI, FIB4 and BARD score positively correlate with alcohol drinking pattern. Hence these scores derived from routine lab investigations could be used as cost effective tools to assess the severity of fibrosis in ALD patients.
50% of those assessed were found to be medium and high risk of malnutrition but it is unclear if they were the patients receiving the correct documentation. Repeat audits could identify this more clearly. We aim to put into place several improvements at ward level to increase compliance. These include; "MUST" calculators, a re-launch of "MUST" screening tools and supporting literature, ward based training. Senior management and ward sisters have been auditing own wards to ensure improvement in compliance with the introduction of ward directed monthly audits. These key clinical indicators of nutrition and hydration have also been based on key recommendations for CQC, DoH and NICE Guidelines.
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