内外科病房营养师会诊预测

Clin Nutr. 2015 Dec;34(6):1141-5.

Predictors of dietitian consult on medical and surgical wards.

Keller H, Allard JP, Laporte M, Davidson B, Payette H, Bernier P, Jeejeebhoy K, Duerksen DR, Gramlich L

Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue, West Waterloo, ON, N2L 3G1, Canada.

Toronto General Hospital, 585 University Avenue, 9N-973, Toronto, ON, M5G 2C4 Canada.

Campbellton Regional Hospitals, 189 Lily Lake Road, PO Box 880, Campbellton, NB, E3N 3H3, Canada.

788 Avondale Avenue, Kitchener, ON, N2M 2W8, Canada.

Université de Sherbrooke, Research Center on Aging, CSSS-IUGS, 1036, Belvedere Street, Sherbrooke, QC, J1H 4C4, Canada.

Jewish General Hospital, 3755 ch Cote Ste-Catherine, Montreal, QC, H3T 1E2, Canada.

St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.

St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada.

Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada.

BACKGROUND & AIM: Guidelines promote dietitian consult (DC) for nutrition support. In Canada, dietitians are involved in the assessment of malnutrition and provide specialized dietary counseling. It is unknown however, what leads to a DC for patients fed orally. This study identifies independent predictors for a DC and determines what is the proportion of malnourished patients seeing a dietitian.

METHODS: The Canadian Malnutrition Task Force conducted a prospective cohort study in medical and surgical wards of 18 Canadian hospitals. 947 patients who did not receive enteral or parenteral nutrition were analyzed. At admission, subjective global assessment (SGA), body mass index, patient demography were collected. During hospitalization clinical data, including dietary intake and presence of a DC were obtained. Multivariate logistic regression was completed with dietitian consult ≤ 3 days and 4 + days as the outcome variables.

RESULTS: The prevalence of malnutrition (SGA B + C) was 45%. Dietitians were consulted for 23% of patients, and of these consults 44% were well nourished (SGA-A), 37% were mildly/moderately malnourished (SGA-B), and 19% were severely malnourished (SGA-C). DC missed 75% of the SGA-B and 60% of SGA-C patients. Predictors of consultation within 3 days of hospitalization were: renal diet (OR 5.75) modified texture diet (OR 5.38), metabolic diagnosis (3.91), ONS use pre-admission (OR 2.33), severe malnutrition (SGA-C, OR 1.88) and age (OR 0.98). Predictors for 4 + days were: dysphagia (OR 11.4), a new medical diagnosis (OR 2.3), severe malnutrition (OR 2.17), constipation (OR 2.16), more than one diagnosis (OR 1.8), antibiotic use (OR 1.6), and male gender (OR 1.6). Consuming < 50% of food in the first week was not a predictor as only 19% of those with low intake had a DC at 4 + days.

CONCLUSIONS: Overall predictors of DC were appropriate but SGA B and C patients and those eating <50% were missed. Screening at admission with algorithms of care that include referral to the dietitian are needed to improve the process of nutrition care.

KEYWORDS: Acute care; Consult; Malnutrition; Registered dietitian

PMID: 25510874

DOI: 10.1016/j.clnu.2014.11.011