TY - JOUR
T1 - Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients
T2 - A diagnostic accuracy study
AU - Bell, J. J.
AU - Bauer, J. D.
AU - Capra, S.
AU - Pulle, R. C.
N1 - Funding Information:
This project was funded in part by a novice researcher’s grant from The Prince Charles Hospital Foundation. We thank members of the NOFEAR (Neck of Femur Education and Research) collaborative and all members of the multidisciplinary team for your dedication to patient care.
PY - 2014/3
Y1 - 2014/3
N2 - Background/Objectives:Differences in malnutrition diagnostic measures impact malnutrition prevalence and outcomes data in hip fracture. This study investigated the concurrent and predictive validity of commonly reported malnutrition diagnostic measures in patients admitted to a metropolitan hospital acute hip fracture unit.Subjects/Methods:A prospective, consecutive level II diagnostic accuracy study (n=142; 8 exclusions) including the International Classification of Disease, 10th Revision, Australian Modification (ICD10-AM) protein-energy malnutrition criteria, a body mass index (BMI) <18.5 kg/m 2, the Mini-Nutrition Assessment Short-Form (MNA-SF), pre-operative albumin and geriatrician individualised assessment.Results:Patients were predominantly elderly (median age 83.5, range 50-100 years), female (68%), multimorbid (median five comorbidities), with 15% 4-month mortality. Malnutrition prevalence was lowest when assessed by BMI (13%), followed by MNA-SF (27%), ICD10-AM (48%), albumin (53%) and geriatrician assessment (55%). Agreement between measures was highest between ICD10-AM and geriatrician assessment (κ=0.61) followed by ICD10-AM and MNA-SF measures (κ=0.34). ICD10-AM diagnosed malnutrition was the only measure associated with 48-h mobilisation (35.0 vs 55.3%; P=0.018). Reduced likelihood of home discharge was predicted by ICD-10-AM (20.6 vs 57.1%; P=0.001) and MNA-SF (18.8 vs 47.8%; P=0.035). Bivariate analysis demonstrated ICD10-AM (relative risk (RR)1.2; 1.05-1.42) and MNA-SF (RR1.2; 1.0-1.5) predicted 4-month mortality. When adjusted for age, usual place of residency, comorbidities and time to surgery only ICD-10AM criteria predicted mortality (odds ratio 3.59; 1.10-11.77). Albumin, BMI and geriatrician assessment demonstrated limited concurrent and predictive validity.Conclusions:Malnutrition prevalence in hip fracture varies substantially depending on the diagnostic measure applied. ICD-10AM criteria or the MNA-SF should be considered for the diagnosis of protein-energy malnutrition in frail, multi-morbid hip fracture inpatients.
AB - Background/Objectives:Differences in malnutrition diagnostic measures impact malnutrition prevalence and outcomes data in hip fracture. This study investigated the concurrent and predictive validity of commonly reported malnutrition diagnostic measures in patients admitted to a metropolitan hospital acute hip fracture unit.Subjects/Methods:A prospective, consecutive level II diagnostic accuracy study (n=142; 8 exclusions) including the International Classification of Disease, 10th Revision, Australian Modification (ICD10-AM) protein-energy malnutrition criteria, a body mass index (BMI) <18.5 kg/m 2, the Mini-Nutrition Assessment Short-Form (MNA-SF), pre-operative albumin and geriatrician individualised assessment.Results:Patients were predominantly elderly (median age 83.5, range 50-100 years), female (68%), multimorbid (median five comorbidities), with 15% 4-month mortality. Malnutrition prevalence was lowest when assessed by BMI (13%), followed by MNA-SF (27%), ICD10-AM (48%), albumin (53%) and geriatrician assessment (55%). Agreement between measures was highest between ICD10-AM and geriatrician assessment (κ=0.61) followed by ICD10-AM and MNA-SF measures (κ=0.34). ICD10-AM diagnosed malnutrition was the only measure associated with 48-h mobilisation (35.0 vs 55.3%; P=0.018). Reduced likelihood of home discharge was predicted by ICD-10-AM (20.6 vs 57.1%; P=0.001) and MNA-SF (18.8 vs 47.8%; P=0.035). Bivariate analysis demonstrated ICD10-AM (relative risk (RR)1.2; 1.05-1.42) and MNA-SF (RR1.2; 1.0-1.5) predicted 4-month mortality. When adjusted for age, usual place of residency, comorbidities and time to surgery only ICD-10AM criteria predicted mortality (odds ratio 3.59; 1.10-11.77). Albumin, BMI and geriatrician assessment demonstrated limited concurrent and predictive validity.Conclusions:Malnutrition prevalence in hip fracture varies substantially depending on the diagnostic measure applied. ICD-10AM criteria or the MNA-SF should be considered for the diagnosis of protein-energy malnutrition in frail, multi-morbid hip fracture inpatients.
KW - albumin
KW - BMI
KW - elderly
KW - hip fractures
KW - hospitals
KW - malnutrition
UR - http://www.scopus.com/inward/record.url?scp=84895818464&partnerID=8YFLogxK
U2 - 10.1038/ejcn.2013.276
DO - 10.1038/ejcn.2013.276
M3 - Article
C2 - 24398643
AN - SCOPUS:84895818464
SN - 0954-3007
VL - 68
SP - 358
EP - 362
JO - European Journal of Clinical Nutrition
JF - European Journal of Clinical Nutrition
IS - 3
ER -
