title: Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting.
abstract: OBJECTIVE
  Numerous nutrition screening tools for the hospital setting have been developed. The aim of this systematic review is to study construct or criterion validity and predictive validity of nutrition screening tools for the general hospital setting.
  
  
  METHODS
  A systematic review of English, French, German, Spanish, Portuguese and Dutch articles identified via MEDLINE, Cinahl and EMBASE (from inception to the 2nd of February 2012). Additional studies were identified by checking reference lists of identified manuscripts. Search terms included key words for malnutrition, screening or assessment instruments, and terms for hospital setting and adults. Data were extracted independently by 2 authors. Only studies expressing the (construct, criterion or predictive) validity of a tool were included.
  
  
  RESULTS
  83 studies (32 screening tools) were identified: 42 studies on construct or criterion validity versus a reference method and 51 studies on predictive validity on outcome (i.e. length of stay, mortality or complications). None of the tools performed consistently well to establish the patients' nutritional status. For the elderly, MNA performed fair to good, for the adults MUST performed fair to good. SGA, NRS-2002 and MUST performed well in predicting outcome in approximately half of the studies reviewed in adults, but not in older patients.
  
  
  CONCLUSIONS
  Not one single screening or assessment tool is capable of adequate nutrition screening as well as predicting poor nutrition related outcome. Development of new tools seems redundant and will most probably not lead to new insights. New studies comparing different tools within one patient population are required.
authors.affiliation: Dept. of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic address: m.vanbokhorst@vumc.nl.
authors.forename: Marian A E
authors.initials: MA
authors.lastname: van Bokhorst-de van der Schueren
authors.affiliation: Dept. of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic address: p.guaitoli@vumc.nl.
authors.forename: Patrícia Realino
authors.initials: PR
authors.lastname: Guaitoli
authors.affiliation: Medical Library, VU Amsterdam University Library, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic address: i.jansma@vu.nl.
authors.forename: Elise P
authors.initials: EP
authors.lastname: Jansma
authors.affiliation: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Electronic address: hcw.devet@vumc.nl.
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
mesh_terms: D006760:Hospitalization; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis*; D015596:Nutrition Assessment; D009752:Nutritional Status; D054928:Validation Studies as Topic
keywords: Assessment; Construct validity; Hospital; Malnutrition; Predictive validity; Screening; Systematic review