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Examining the accuracy of Malnutrition Screening Tool (MST) in screening adult patients

admitted to X Hospital, Y Hospital, and Z Medical Center at risk for malnutrition in


comparison with the each hospital's approved screening method, using the Academy of
Nutrition and Dietetics Guidelines for malnutrition as a method of comparison
C. Lim, L. Homiak, & M. Evans
Aramark Distance Dietetic Internship

Abstract

METHODOLOGY
Cross-sectional research design; a group of participants who matches the criteria are
surveyed at a single point in time.

This study examined whether the MST is more accurate at screening for risk of malnutrition
than the involved hospitals approved screening method, based on the Academy of Nutrition and
Dietetics guidelines for malnutrition
44 participants in this study were patients selected from X Hospital, Y Hospital, and Z Medical
Center
Participants were screened as moderate or high nutritional risk, and given a pre-MST by the
interns or RDs based on the information available to them at the time of screening
Following the full nutrition assessment and exam, participants were given a post-MST score.
Pre and Post MST scores were compared at the end the data collection process
The Pre MST score exhibited a 56% accuracy, while the post MST score exhibited a higher
accuracy of 79%.
Conclusion: MST is more efficient and accurate than the current hospital screening tools used
at each hospital involved in this study

Qualified dietetic interns and the registered dietitians at their sites gathered all data. Data
gathered from registered dietitians was released to the dietetic intern.
Data was collected on all patients screened to be at a moderate or high nutritional risk.
Exclusion criteria includes: children and adolescent ages <18, pregnant women.
Patient information was obtained from patient electronic medical records. Dietitians and
dietetic interns gathered weight history from patient interviews as needed.

DISCUSSION

Data was collected over two and a half months at all three hospitals
In the end, there was a total of 44 participants, 23 were males and 21 were
females and between 28 and 91 years old
Pre-MST scores are based on the information available to the dietitian or dietetic
intern when they receive the nutrition consult from the hospital's current approved
nutrition screen that is administered to each patient at the time they are admitted.
Post-MST scores are based on the information obtained by the dietitian or dietetic
intern from the patients medical record or from the patient themself
The academys guidelines for malnutrition were used to determine if the pre and
post screen was accurate
Pre and post scores from each hospital were compared:
Graph 1: (below) shows each individual hospitals pre and post scores

The study began by determining what the objective was going to be. We
wanted to determine if the MST can accurately identify patients at nutritional
risk, in comparison to each involved hospitals current screening tool, with
the academy of nutrition and dietetics guidelines for malnutrition used as a
measure of accuracy
During the methodology, the study was set to be a cross-sectional study
and the information needed to be collected was discussed
For 2.5 months, data was collected at each hospital. In the end, there were
44 participants and it was determined that the MST was accurate.
Strengths: increased understanding of MST, results consistent with
previous studies (quick, easy, and convenient), and achieved what we set
out to find
Weaknesses: start on different pages, no MST at any sites,
miscalculating, and inaccurate information from screen or patient

The dietetic interns then compiled all findings into one document.
Data was reviewed and analyzed by the dietetic interns involved in this research project.

INTRODUCTION

RESEARCH QUESTION/OBJECTIVE
Answer the research question:
Can the Malnutrition Screening Tool (MST) accurately screen adult patients admitted to X
Hospital, Y Hospital, and Z Medical Center for malnutrition in comparison with the each
hospital's approved screening method, using the Academy of Nutrition and Dietetics Guidelines
for malnutrition as a method of comparison?

For additional information, please contact:


Megan Evans, Aramark Dietetic Intern
meg.evans.00@gmail.com
Lisa Homiak, Aramark Dietetic Intern
lisahomiak@gmail.com
Crystal Lim, Aramark Dietetic Intern
CrystalTyLim@gmail.com

RESULTS

CONCLUSION

The MST, NFPE, and AND guidelines for malnutrition were utilized to compare malnutrition
identification accuracy against the three hospitals screening tools.

Malnutrition is associated with longer length of hospital stay and increase in medical
complications1
Prevalence of malnutrition in the hospital setting can be as high as 50%2
The purpose of nutrition screens is to quickly and accurately identify patients at risk and those
likely to become at nutritional risk1
Screening methods used are short, quick, easy-to-use, and cost-effective
Most screening assessments include: history of weight loss, decrease in appetite, current need
for nutrition support, skin breakdown, and chronic use of modified diets1
MST created based on study conducted by Ferguson et al. in 1999- based on scores of 2
questions:3
1. Have you recently lost weight without trying?
2. Have you been eating poorly because of a decreased appetite?
Malnourished patients who are identified and addressed are found to have shorter length of
hospital stay, lower rates of readmission, and better outcomes overall6
Effective and efficient methods of detecting malnutrition is important for early intervention,
prevention of prolonged hospital stays, and creating reimbursement for services5
It may also be associated with usage of less invasive and unnecessary procedures, and
fewer complications from inappropriate medications5
Hospitals in which the study was conducted include: X Hospital, Y Hospital, and Z Medical
Center

CONTACT INFORMATION

The NFPE is a visual and/or physical examination of the patient that helps to validate the
malnutrition diagnosis.
The following is a more comprehensive list of AND criteria:
energy intake, interpretation of
Clinical

Age
NFPE: Identify
Reason For Nutrition MST
diet
order,
BMI,
diagnosis.
and weight loss,
Score
any indicators
Consult
Gender (ex: RN, MD, or RD)
for Nutritional
Risk

Hospital

Pre-MST Score > 2

Pre-MST Score < 2

Characteristics:
Identify any
indicators for
Nutritional Risk

Post-MST Score > 2

Did the MST &/or the


hospital approved
screening tool correctly
identify malnutrition?

Once all the scores were categorized into pre-MST >2, pre-MST <2, post-MST >2,
and post-MST <2, the scores were totaled and then compared to the number of
actual malnourished patients in each category. This was to determine the
accuracy of the screen.
Graph 2 (Below): Shows the accuracy.

Hospital screening tools include a variety of conditions that would put a patient at
nutritional risk. Further evaluation of these patients during nutrition assessments by a
Registered Dietitian may be involved in the prevention of malnutrition development
Results from this study supports the results from previous studies conducted
Post MST scores showed to be more accurate when it came to identifying patients at
nutritional risk, with a 79% accuracy rating when the pre MST accuracy rating was only
56%. MST proved to be more efficient and accurate when compared to current
hospital screening tools used at the three hospitals involved in this study
Future studies that include larger sample sizes and multiple groups of specific
populations can increase the validity and reliability of study results
Results from this study and future studies can help dietitians prioritize patients

Post-MST Score < 2

accurately and implement the nutrition care process for those at the highest risk for
malnutrition
X

19

13

5
1.

11

Total:

25

19

29

15

# of actual
malnourished
patients*

14

12

23

10

REFERENCES

Mahan, L, Escott-Stump, S, Raymond, J. Krauses Food and the Nutrition Care Process. St. Louis, MO: W.B. Saunders;
2012

2.

The post-MST identified patients at nutritional risk accurately 79% of the time and
identified those not at risk 33% of the time
The pre-MST identified patients at nutritional risk accurately 56% of the time and
identified those not at risk 37% of the time
Results prove the MST can accurately identify patients at risk for malnutrition

Kayashita, A, Yamato, H, Yoshida, I, Matsuzaki, K, Niki, H, Nagae, H, Miyamoto, K. Evaluation of 14 questions detecting
malnutrition in newly hospitalization patients. The Journal of Medical Investigation. 2013; 60:138-145.

3.

Ferguson, M, Capra, S, Bauer, J, Banks, M, Development of a valid and reliable malnutrition screening tool for adult acute
hospital patients. Nutrition. 1999; 12(6):458-464.

4.

White, J, Guenter, P, Jensen, G, Malone, A, Schofield, M. Consensus Statement of the Academy of Nutrition and Dietetics/
American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and
Documentation of Adult Malnutrition (Undernutrition). Journal Of The Academy Of Nutrition & Dietetics. 2012;112(5):

% Accuracy

56%

37%

79%

730-738.

33%
5.

Rhea M, Bettles C. Future changes driving dietetics workforce supply and demand: future scan 2012-2022. Academy of
Nutrition and Dietetics. 2012; 112(3): 10-24.

6.

Varela, V, Delgado, G. Risk of malnutrition associated with poor food intake prolonged hospital stay and readmission in high
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complexity hospital in Colombia. Nutrition Hospitalaria. 2015; 32(3): 1308-1314.