Quick and easy is not without cost: Implications of poorly performing nutrition screening tools in hip fracture

Bell, Jack J., Bauer, Judith D., Capra, Sandra and Pulle, Ranjeev C. (2014) Quick and easy is not without cost: Implications of poorly performing nutrition screening tools in hip fracture. Journal of the American Geriatrics Society, 62 2: 237-243. doi:10.1111/jgs.12648

Author Bell, Jack J.
Bauer, Judith D.
Capra, Sandra
Pulle, Ranjeev C.
Title Quick and easy is not without cost: Implications of poorly performing nutrition screening tools in hip fracture
Journal name Journal of the American Geriatrics Society   Check publisher's open access policy
ISSN 0002-8614
Publication date 2014-01-01
Year available 2014
Sub-type Article (original research)
DOI 10.1111/jgs.12648
Open Access Status Not yet assessed
Volume 62
Issue 2
Start page 237
End page 243
Total pages 7
Place of publication Hoboken, NJ United States
Publisher Wiley-Blackwell Publishing, Inc.
Language eng
Subject 2717 Geriatrics and Gerontology
Abstract Objectives To evaluate the performance of commonly applied nutrition screening tools and measures and to consider the potential costs of undiagnosed malnutrition in a case-based reimbursement funding environment. Design A diagnostic accuracy study to compare a variety of nutrition screening techniques against primary, secondary, and comparative measures of nutritional status. Setting Public metropolitan hospital orthogeriatric unit. Participants Individuals with acute hip fracture admitted to the orthogeriatric unit; 150 prospective, consecutively admitted individuals were considered, with eight exclusions, yielding a sample size of 142 participants. Measurements Screens included the Mini Nutritional Assessment - Short Form, Malnutrition Screening Tool, Malnutrition Universal Screening Tool, Nutrition Risk Screen 2002, anthropometric measures, and albumin. Malnutrition was diagnosed using International Statistical Classification of Diseases and Health Related Problems, Tenth Edition, Australian Modification (ICD-10-AM) criteria. Healthcare coders costed malnutrition-related diagnostic related groups and cost-weight changes for individual participants. Results Malnutrition prevalence was 48%. Screening tools had only slight to moderate agreement with ICD-10-AM diagnosis of malnutrition, and none of the screening tools tested met the a priori requirement of 80% sensitivity and 60% specificity. The estimated cost effect of poor screening tool sensitivity on a 16-bed hip fracture unit ranged from AUS46,506 to AUS228,896 per year. Conclusion Poor screening tool sensitivity leads to undiagnosed malnutrition; tools that are quick and easy to apply are not without cost. Routine nutrition assessment should replace nutrition risk screening in hip fracture settings with a high prevalence of malnutrition reliant on case-mix funding. Further pragmatic studies are urgently required to determine whether findings apply to other elderly inpatient populations with endemic malnutrition, comorbidities, and cognitive impairment.
Keyword Elderly
Hip fractures
Nutrition screening
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Human Movement and Nutrition Sciences Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 15 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 18 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 04 Mar 2014, 10:46:45 EST by System User on behalf of School of Human Movement and Nutrition Sciences