The Malnutrition Screening Tool versus objective measures to detect malnutrition in hip fracture

Bell, Jack J.; Bauer, Judy; Capra, Sandra

doi:10.1111/jhn.12040

Cited by 25 publications

(22 citation statements)

References 43 publications

(92 reference statements)

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“…However, a compliance rate of only 50–75% has been indicated in hospitals that reported auditing of the process . Our study found a completed screening rate of 84–92%, similar to that reported by other studies in the rehabilitation setting . The nutrition assistants were more reliable than nursing staff in completing the MSTs.…”

Section: Discussionsupporting

confidence: 87%

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Use of the malnutrition screening tool by non‐dietitians to identify at‐risk patients in a rehabilitation setting: A validation study

Wester

Angus

Easlea

et al. 2018

Nutrition & Dietetics

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Section: Discussionsupporting

confidence: 87%

“…9 Our study found a completed screening rate of 84-92%, similar to that reported by other studies in the rehabilitation setting. 24 The nutrition assistants were more reliable than nursing staff in completing the MSTs. Nursing staff failed to screen twice as many patients.…”

Section: Discussionmentioning

confidence: 99%

Use of the malnutrition screening tool by non‐dietitians to identify at‐risk patients in a rehabilitation setting: A validation study

Wester

Angus

Easlea

et al. 2018

Nutrition & Dietetics

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“…Whilst no a priori assumptions were made the treatment team was not at all surprised that the most commonly applied and recommended nutrition screening tools were highlighted as performing poorly in routine clinical practice despite previously published explanatory studies purporting their validity for this purpose; this was demonstrated to lead to substantial patient and healthcare implications [29,30]. Another diagnostic accuracy study reported that measures of malnutrition most commonly applied in nutritionally focused hip fracture RCTs were not useful for this purpose when applied in routine clinical practice [32].…”

Section: Resultsmentioning

confidence: 99%

“…As an example, studies investigating nutrition care in hip fracture have demonstrated a high likelihood of study bias, and consequently describe inclusion of younger, less comorbid, and less cognitively, functionally or physically impaired patients compared with that encountered in routine clinical practice [35,36]. Highly explanatory trials have also reported rates of malnutrition risk, malnutrition, unfavourable postoperative outcomes, and/or mortality less than that observed or expected [29,30,32,33,36]. These skewed research populations are considered likely to have diluted or negated the potential effect of interventions under investigation and have also limited the applicability of outcomes to routine clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Phase I built on baseline data and observed whether commonly applied nutrition screening and assessment processes may present as barriers to nutrition care in hip fracture and included two diagnostic accuracy studies and a prospective, consecutive case series [29,30,32,33]. Phase II reported a further prospective, consecutive case series to quantitatively investigate protein-energy intakes in post hip-fracture inpatients.…”

Section: Methodsmentioning

confidence: 99%

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Developing and evaluating interventions that are applicable and relevant to inpatients and those who care for them; a multiphase, pragmatic action research approach

Bell

Rossi

Bauer

et al. 2014

BMC Med Res Methodol

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BackgroundRandomised controlled trials may be of limited use to evaluate the multidisciplinary and multimodal interventions required to effectively treat complex patients in routine clinical practice; pragmatic action research approaches may provide a suitable alternative.MethodsA multiphase, pragmatic, action research based approach was developed to identify and overcome barriers to nutritional care in patients admitted to a metropolitan hospital hip-fracture unit.ResultsFour sequential action research cycles built upon baseline data including 614 acute hip-fracture inpatients and 30 purposefully sampled clinicians. Reports from Phase I identified barriers to nutrition screening and assessment. Phase II reported post-fracture protein-energy intakes and intake barriers. Phase III built on earlier results; an explanatory mixed-methods study expanded and explored additional barriers and facilitators to nutritional care. Subsequent changes to routine clinical practice were developed and implemented by the treating team between Phase III and IV. These were implemented as a new multidisciplinary, multimodal nutritional model of care. A quasi-experimental controlled, ‘before-and-after’ study was then used to compare the new model of care with an individualised nutritional care model. Engagement of the multidisciplinary team in a multiphase, pragmatic action research intervention doubled energy and protein intakes, tripled return home discharge rates, and effected a 75% reduction in nutritional deterioration during admission in a reflective cohort of hip-fracture inpatients.ConclusionsThis approach allowed research to be conducted as part of routine clinical practice, captured a more representative patient cohort than previously reported studies, and facilitated exploration of barriers and engagement of the multidisciplinary healthcare workers to identify and implement practical solutions. This study demonstrates substantially different findings to those previously reported, and is the first to demonstrate that multidisciplinary, multimodal nutrition care reduces intake barriers, delivers a higher proportional increase in protein and energy intake compared with baseline than other published intervention studies, and improves patient outcomes when compared with individualised nutrition care. The findings are considered highly relevant to clinical practice and have high translation validity. The authors strongly encourage the development of similar study designs to investigate complex health problems in elderly, multi-morbid patient populations as a way to evaluate and change clinical practice.

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Are hip fracture patients with high or low body mass index at higher risk of missed care? A cohort study

2023

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Aim To examine whether patients' body mass index is associated with missed hip fracture care consistent with national guideline‐recommended care. Design A nationwide, population‐based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry. Methods The study population consisted of 39,835 patients ≥65 years admitted with a hip fracture and discharged between 1st of January 2012 and 29th of November 2017. National guideline‐recommended care consists of preoperative optimization, early surgery, mobilization within 24 h, basic mobility assessment, nutrition screening, post‐discharge rehabilitation program, and osteoporotic and fall prophylaxis. We used binomial regression to estimate the relative risk for the fulfilment of the individual measures with 95% confidence interval. Multiple imputation method was applied to handle missing values of body mass index. Results The overall fulfilment of the individual measures ranged from 43% for pre‐operative optimization to 95% for receiving a post‐discharge rehabilitation program. The obese patients had a lower fulfilment of surgery within 36 h compared to patients with normal weight. No differences in fulfilment of the other measures were found. However, patients with missing data on body mass index had the highest risk of missed care. In conclusion, patients with missing BMI values had the highest risk of missed care. The obese patients had a slightly higher risk of long waiting times for surgery than normal‐weighted patients. No Patient or Public Contribution This study was done based on population‐based data from medical registries and data was analysed by the authors only.

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The Malnutrition Screening Tool versus objective measures to detect malnutrition in hip fracture

Cited by 25 publications

References 43 publications

Use of the malnutrition screening tool by non‐dietitians to identify at‐risk patients in a rehabilitation setting: A validation study

Use of the malnutrition screening tool by non‐dietitians to identify at‐risk patients in a rehabilitation setting: A validation study

Developing and evaluating interventions that are applicable and relevant to inpatients and those who care for them; a multiphase, pragmatic action research approach

Are hip fracture patients with high or low body mass index at higher risk of missed care? A cohort study

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