Based on the available evidence, which nutrition screening tools have been found to be valid and reliable for identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
Eleven nutrition screening tools were evaluated for validity and reliability to identify nutrition problems in acute care and hospital-based ambulatory care settings. Tools for which there were Grade I and II evidence were ranked in terms of the highest sensitivity and specificity.
Grade I evidence was available for one tool (NRS-2002) , and Grade II evidence was available for four tools (Simple Two-Part Tool, MST, MNA-SF and MUST). Tools in the highest quartile for sensitivity (>83%) and specificity (>90%) included the following:
MNA-SF: Sensitivity >90%; Specificity >90% (1 of 2 studies)
MST: Sensitivity >90% (3 of 4 studies); Specificity > 90% (2 of 4 studies)
Of the tools with high sensitivity and specificity, one tool was evaluated for inter-rater reliability using a kappa statistic. The MST had a kappa score of 0.83 to 0.88. No data were available to evaluate the reliability of the MNA-SF.
Based on the available evidence, the MST has been shown to be both valid and reliable for identifying nutrition problems in acute care and hospital-based ambulatory care settings. While the MNA-SF has been found to be valid, no data are available to evaluate the reliability of the tool.
Care must be taken when applying these conclusions beyond the populations studied. The MST was studied in adults in acute care and oncology outpatient settings. The MNA-SF was studied in the geriatric population in acute inpatient, subacute and ambulatory settings. Research is needed to determine the validity and reliability of these three screening tools in other populations.
Future nutrition screening research should include the following elements:
Validate the screening tool against an appropriate gold standard (reference standard)
Evaluate sensitivity, specificity, reliability, PPV, NPV and when relevant, agreement
Report findings in a format consistent with international guidelines* to facilitate comparison to other studies.
*Moher D, Schulz KF, Altman DG. The CONSORT statement: Revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med 2001; 134 (8): 657-662.
*Altman DG, Schulz KF, Moher D, Egger M. Davidoff F, Elbourne D, Gotzsche PC, Lang T. The revised CONSORT statement for reporting randomized trials: Explanation and elaboration. Ann Intern Med 2001; 134 (8): 663-694.
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.