title: Physical assessment and anthropometric measures for use in clinical research conducted in critically ill patient populations: an analytic observational study.
abstract: BACKGROUND
  Accurate assessment of nutrition status is essential in identifying subpopulations of critically ill patients who are malnourished and at higher mortality risk. The aim of this analytic observational study was to assess the performance of physical assessment and anthropometric measures commonly used in clinical research.
  
  
  METHODS
  A prospective study was undertaken in 31 intensive care units (ICUs) with a focus on patients with short-term contraindications to enteral nutrition. Within 24 hours of admission to the ICU, the following measures were collected: the Subjective Global Assessment components measuring subcutaneous fat loss and muscle wasting, height, weight, mid-upper-arm circumference, and triceps skinfold thickness (TSF). Mid-arm muscle circumference and body mass index (BMI) were calculated. BMI was assessed as a continuous variable and categorized according to the World Health Organization (WHO) categories. The primary outcome was hospital discharge mortality.
  
  
  RESULTS
  In total, 1363 patients were enrolled. BMI, analyzed according to WHO categories (P = .09), and TSF (P = .32) failed to demonstrate statistically significant predictive ability. TSF failed to demonstrate statistically significant clinical utility (area under the receiver operating characteristic curve, 0.52; 95% confidence interval, 0.48-0.56). All other individual measures demonstrated statistically significant predictive ability and statistically significant clinical utility.
  
  
  CONCLUSIONS
  On the basis of the results of our ICU cohort, we recommend caution when using BMI categorized according to WHO definitions. We cannot recommend collection of TSF. More research is required to understand reliability, performance, and use before our results are able to be generalized to other ICU populations.
authors: Northern Clinical School Intensive Care Research Unit, University of Sydney, NSW, Australia.
authors: Fiona
authors: F
authors: Simpson
authors: Northern Clinical School Intensive Care Research Unit, University of Sydney, NSW, Australia gdoig@med.usyd.edu.au.
authors: Gordon S
authors: GS
authors: Doig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D019540:Area Under Curve; D001132:Arm; D015992:Body Mass Index; D001835:Body Weight; D001837:Body Weights and Measures; D000075202:Contraindications; D016638:Critical Illness / Q000401:mortality; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000517:prevention & control; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D015596:Nutrition Assessment; D009752:Nutritional Status; D010808:Physical Examination; D011446:Prospective Studies; D012372:ROC Curve; D012885:Skinfold Thickness; D050151:Subcutaneous Fat
keywords: anthropometric measurements; baseline confounding; clinical research; critical care; intensive care unit; physical assessment