老師 : 陳慧君老師 學生 : 郭雅婷 陳冠恩 報告日期 : 2012/12/28

1. Research Project: pilot study Comparing NTUH-nutritional screening tool with common-used nutritional screening tools 老師: 陳慧君老師 學生: 郭雅婷 陳冠恩 報告日期:2012/12/28

2. Purpose

3. In order to improve validity of NTUH nutrition screen tool, the first purpose of this project was to compare the difference of high-risk rate for malnutrition between international nutritional screening tools and NTUH nutrition screening tool used currently. Then, the second purpose was to evaluate the sensitivity and specificity of NTUH tool. Purpose

4. Materials and Methods

5. Materials & Methods Total subjects :41 patients (16 men，25women) Duration:2012/9/20~ 2012/11/1 Timing :Admission within 24 hours Condition :Age>18y The ward types:From Subjects

6. Materials & Methods • Nutritional screening tools: • (1) Malnutrition Universal Screening Tool (MUST) • (2) Nutritional Risk Screening 2002 (NRS 2002) • (3) NTUH malnutrition screening tool. Tools for Assessing nutritional risk

7. Materials & Methods • Overall risk of malnutrition is established as presented in Table 1.

8. 放一張MUST篩檢表的圖 MUST Nutritional intervention

9. Materials & Methods Nutritional risk is established according to the rating in Table 1.

10. Figure 2. NRs2002 If total score ≧3 Nutritional intervention

11. Materials & Methods • 1. 疾病類別 • 2. 進食量<50% or NPO≧3 days Diarrhea : 3次/日 ≧ 3 days BMI < 18 or BMI > 30 病人自覺1mo內體重有無下降 • 3. 項目≧2 • 直接放圖講解 NTUH Select the disease To judgment the patient's condition If Score ≧2 Nutritional intervention

12. Materials & Methods Table 1. Malnutrition cut-points Nutritional intervention

13. Materials & Methods • Since there is no gold standard for patients we decided to calculate a combined index as a reference tool. • Malnutrition Cut-point: • if the patient is evaluated at risk of malnutrition according to at least two out of three pre-mentioned tools, this patient was categorized as malnutrition in the combined index classification. Combined Index

14. Materials & Methods • chi squared test: It is used to compare malnutrition rate between different nutritional screening tools. Statistical Analysis

15. Sensitivity ＆ Specificity • The combined index was considered the criterion of true malnutrition. Malnutrition patients by both the nutritional tool and the combined index Malnutrition by the combined index but not from the nutritional tool Malnutrition by the nutritional tool but not by the combined index Not malnutrition either by the nutritional screening tool or by the combined index A (A+B) sensitivity = D (C+D) specificity =

16. Result

17. Results Patient characteristics Table 2.

18. Table 3. Cause of Admission

19. Results 各篩檢表營養不良比率 Table 4. P值 <0.05 具有顯著的差異

20. Results 各病房之營養不良風險

21. Results BMI與營養不良風險之關係

22. Results 敏感度＆精確度 • 敏感度: NRS 2002 > MUST > NTUH • 精確度: NRS 2002 > NTUH > MUST

23. Discussion

24. 1.造成台大篩檢表營養不良篩檢率偏低的因素有哪些?1.造成台大篩檢表營養不良篩檢率偏低的因素有哪些? 評估項目裡未將疾病嚴重度列入分數計算中。 與其他篩檢表比較下發現,病人或家屬對於<體重下降>較無自覺! 因為NTUH表中的4項篩選結果在NRS2002和MUST中都占有比較多的分數,可是NTUH須同時符合2項以上才歸類於營養不良,所以營養不良率會偏低。

25. 2.建議增加哪些項目來提升台大營養篩檢表的敏感度和精確度?2.建議增加哪些項目來提升台大營養篩檢表的敏感度和精確度? A: (1) 將各項疾病嚴重度列入評分(如下頁範例) (2)建議將<病人自覺最近1個月內體重有無明顯變化>改為 →1個月內體重下降幅度(≦5% ,5-10% , ≧10%) 給予不同程度的分數。 (3)若將需營養介入的判定點由≧2項改為≧1項,則營養不良篩檢率便會接近 NRS2002與MUST。

26. 各項疾病嚴重度評分表 – NTUH版 26 參考自NRS 2002 疾病嚴重度評分表

27. 3.為何13A和13B的營養不良率為0 ? A: 抽樣人數不足

28. 4. 評估病人營養風險時判斷的優先順序? (例:BMI / 體重流失(幾個月內?) / 進食量) A: 以嚴重度高者為優先評分標準

29. Thanks for your attention!