title: Is undernutrition risk associated with an adverse clinical outcome in spinal cord-injured patients admitted to a spinal centre?
abstract: OBJECTIVE
  To evaluate whether undernutrition risk measured using the Spinal Nutrition Screening Tool (SNST) and the Malnutrition Universal Screening Tool (MUST) is associated with worse clinical outcomes in respect of length of in-patient hospital stay (LOS) and mortality in the 12 months after admission to a spinal cord injuries (SCIs) centre.
  
  
  METHODS
  A multicentre, prospective, cross-sectional observational study was conducted in four UK SCI centres (SCICs). A total of 150 SCI patients (aged 18-88 years (median: 44 years), 30.7% females) were studied between July 2009 and March 2010. LOS and mortality 12 months after admission to the SCIC was monitored. Multivariate regression analysis was used to identify unique predictors of the variance of LOS.
  
  
  RESULTS
  The patients initially undernourished or at risk of undernutrition (44.6%) had a significantly longer LOS (median (days): 129 vs 85, P=0.012) and greater 12-month mortality (% deceased: 9.2% vs 1.4%, P=0.036). In addition, serum albumin and new admission to an SCIC were identified as independent predictors for long LOS.
  
  
  CONCLUSIONS
  The present study suggests that undernutrition risk, as identified by the SNST, is associated with adverse clinical outcomes. Nutritional screening should be helpful in improving clinical outcomes if it promotes more appropriate and effective nutritional intervention.
authors.affiliation: 1] National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK [2] School of Health Sciences, City University, London, UK [3] Centre for Gastroenterology and Clinical Nutrition, University College, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Wong
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.
authors.forename: F
authors.initials: F
authors.lastname: Derry
authors.affiliation: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.
authors.forename: A
authors.initials: A
authors.lastname: Jamous
authors.affiliation: School of Health Sciences, City University, London, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Hirani
authors.affiliation: Centre for Gastroenterology and Clinical Nutrition, University College, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Forbes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult