title: The malnutrition screening tool versus objective measures to detect malnutrition in hip fracture.
abstract: BACKGROUND
  The Malnutrition Screening Tool (MST) is the most commonly used screening tool in Australia. Poor screening tool sensitivity may lead to an under-diagnosis of malnutrition, with potential patient and economic ramifications. The present study aimed to determine whether the MST or anthropometric parameters adequately detect malnutrition in patients who were admitted to a hip fracture unit.
  
  
  METHODS
  Data were analysed for a prospective convenience sample (n = 100). MST screening was independently undertaken by nursing staff and a nutrition assistant. Mid upper arm circumference (MUAC) was measured by a trained nutrition assistant. Nutritional risk [MST score ≥ 2, body mass index (BMI) < 22 kg m(-2) , or MUAC < 25 cm] was compared with malnutrition diagnosed by accredited practicing dietitians using International Classification of Diseases version 10-Australian Modification (ICD10-AM) coding criteria.
  
  
  RESULTS
  Malnutrition prevalence was 37.5% using ICD10-AM criteria. Delirium, dementia or preadmission cognitive impairment was present in 65% of patients. The BMI as a nutrition risk screen was the most valid predictor of malnutrition (sensitivity 75%; specificity 93%; positive predictive value 73%; negative predictive value 84%). Nursing MST screening was the least valid (sensitivity 73%; specificity 55%; positive predictive value 50%; negative predictive value 77%). There was only fair agreement between nursing and nutrition assistant screening using the MST (κ = 0.28).
  
  
  CONCLUSIONS
  In this population with a high prevalence of delirium and dementia, further investigation is warranted into the performance of nutrition screening tools and anthropometric parameters such as BMI. All tools failed to predict a considerable number of patients with malnutrition. This may result in the under-diagnosis and treatment of malnutrition, leading to case-mix funding losses.
authors.affiliation: Department of Nutrition and Dietetics, The Prince Charles Hospital, Queensland Health, Brisbane, Queensland, Australia; Centre for Dietetics Research, School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: J J
authors.initials: JJ
authors.lastname: Bell
authors.forename: J D
authors.initials: JD
authors.lastname: Bauer
authors.forename: S
authors.initials: S
authors.lastname: Capra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology; D003704:Dementia / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006620:Hip Fractures / Q000503:physiopathology; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology*; D008403:Mass Screening; D008485:Medical Audit; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
keywords: body mass index; elderly; hip fracture; malnutrition; nutrition screening