外科医师与营养专家对营养风险评分的应用情况

瑞士洛桑沃州大学中心医院

　　外科医师营养状况评定能力一般。应该建议与营养专家密切合作以避免有营养风险患者的误诊和治疗不足。

Clin Nutr. 2016 Feb;35(1):230-3.

Use of the nutritional risk score by surgeons and nutritionists.

Benoit M, Grass F, Demartines N, Coti-Bertrand P, Schäfer M, Hübner M.

University Hospital CHUV, Lausanne, Switzerland.

BACKGROUND: The Nutritional Risk Score (NRS) is a validated tool to identify patients who should benefit of nutritional interventions. Nutritional screening however has not yet been widely adopted by surgeons. Furthermore, the question about reliability of nutritional assessment performed by surgeons is still unanswered.

METHODS: Data was obtained from a recent randomised trial including 146 patients with an NRS ≥3 as assessed by the surgeons. Additional detailed nutritional assessment was performed for all patients by nutritional specialists and entered prospectively in a dedicated database. In this retrospective, surgeons' scoring of NRS and its components was compared to the assessment by nutritionists (considered as gold standard).

RESULTS: Prospective NRS scores by surgeons and nutritionists were available for 141 patients (97%). Surgeons calculated a NRS of 7, 6, 5, 4 and 3 in 2, 8, 38, 21 and 72 patients respectively. Nutritionists calculated a NRS of 6, 5, 4, 3 and 2 in 8, 26, 47, 57, 3 patients, respectively. Surgeons' assessment was entirely correct in 56 patients (40%), while at least the final score was consistent in 63 patients (45%). Surgeons overrated the NRS in 21% of patients and underestimated the score in 29%. Evaluation of the nutritional status showed most of the discrepancies (54%).

CONCLUSION: Surgeon's assessment of nutritional status is modest at best. Close collaboration with nutritional specialists should be recommended in order to avoid misdiagnosis and under-treatment of patients at nutritional risk.

KEYWORDS: Nutritional risk score; Nutritional screening; Perioperative nutrition; Reliability

PMID: 25661800

DOI: 10.1016/j.clnu.2015.01.014