炎性肠病门诊患者使用营养不良通用筛查工具自我筛查营养不良风险

　　营养不良常见于炎性肠病患者且与其不良结局相关。加拿大西安大略大学、沙特阿拉伯阿卜杜勒阿齐兹国王大学、加拿大麦吉尔大学为了明确患者使用营养不良通用筛查工具（MUST）自己进行营养不良筛查与医务工作者评分（金标准）相比是否可靠，在加拿大三级学术中心开展了一项前瞻验证研究，其中包括154例门诊炎性肠病成年患者。所有炎性肠病患者利用MUST评分完成自我营养筛查评估后由医务工作者进行独立MUST评估。主要结局指标为营养不良风险分类几率校正（κ）一致性。

　　结果发现，自行MUST评估的患者，与医务工作者筛查出的低风险和中高风险患者相比，几率校正一致性κ为0.83（95%置信区间：0.74～0.92）。比较所有3个风险组的加权κ分析得出患者和医务工作者筛查的κ为0.85（95%置信区间：0.77～0.93）。所有患者能够自行筛查。总体上，96%的患者报告MUST问卷很容易或容易理解和完成。

　　因此，炎性肠病门诊患者使用MUST筛查工具自行营养筛查有效且容易。如果该工具被采用，将增加繁忙门诊情况下的门诊患者营养不良筛查实施，并有助于医务工作者确定哪些患者需要附加营养支持。

JPEN J Parenter Enteral Nutr. 2016;40(4):507-10.

Self-Screening for Malnutrition Risk in Outpatient Inflammatory Bowel Disease Patients Using the Malnutrition Universal Screening Tool (MUST).

Sandhu A, Mosli M, Yan B, Wu T, Gregor J, Chande N, Ponich T, Beaton M, Rahman A.

Western University, London, Ontario, Canada; King Abdulaziz University, Jeddah, Saudi Arabia; McGill University, Montreal, Canada.

BACKGROUND AND AIMS: Malnutrition is common in patients with inflammatory bowel disease (IBD) and is associated with poor outcomes. Our aim is to determine if patient self-administered malnutrition screening using the malnutrition universal screening tool (MUST) is reliable by comparing patient scores with those derived from the healthcare practitioner (HCP), the gold standard.

METHODS: We conducted a prospective validation study at a tertiary Canadian academic center that included 154 adult outpatients with IBD. All patients with IBD completed a self-administered nutrition screening assessment using the MUST score followed by an independent MUST assessment performed by HCPs. The main outcome measure was chance-corrected agreement (κ) of malnutrition risk categorization.

RESULTS: For patient-administered MUST, the chance-corrected agreement κ (95% confidence interval [CI]) was 0.83 (0.74-0.92) when comparing low-risk and combined medium- and high-risk patients with HCP screening. Weighted κ analysis comparing all 3 risks groups yielded a κ (95% CI) of 0.85 (0.77-0.93) between patient and HCP screening. All patients were able to screen themselves. Overall, 96% of patients reported the MUST questionnaire as either very easy or easy to understand and to complete.

CONCLUSION: Self-administered nutrition screening in outpatients with IBD is valid using the MUST screening tool and is easy to use. If adopted, this tool will increase utilization of malnutrition screening in hectic outpatient clinic settings and will help HCPs determine which patients require additional nutrition support.

PMID: 25632031

DOI: 10.1177/0148607114566656