title: A novel, automated nutrition screening system as a predictor of nutritional risk in an oncology day treatment unit (ODTU).
abstract: OBJECTIVE
  Paper-based nutrition screening tools can be challenging to implement in the ambulatory oncology setting. The aim of this study was to determine the validity of the Malnutrition Screening Tool (MST) and a novel, automated nutrition screening system compared to a 'gold standard' full nutrition assessment using the Patient-Generated Subjective Global Assessment (PG-SGA).
  
  
  METHODS
  An observational, cross-sectional study was conducted in an outpatient oncology day treatment unit (ODTU) within an Australian tertiary health service. Eligibility criteria were as follows: ≥ 18 years, receiving outpatient anticancer treatment and English literate. Patients self-administered the MST. A dietitian assessed nutritional status using the PG-SGA, blinded to the MST score. Automated screening system data were extracted from an electronic oncology prescribing system. This system used weight loss over 3 to 6 weeks prior to the most recent weight record or age-categorised body mass index (BMI) to identify nutritional risk. Sensitivity and specificity against PG-SGA (malnutrition) were calculated using contingency tables and receiver operating curves.
  
  
  RESULTS
  There were a total of 300 oncology outpatients (51.7% male, 58.6 ± 13.3 years). The area under the curve (AUC) for weight loss alone was 0.69 with a cut-off value of ≥ 1% weight loss yielding 63% sensitivity and 76.7% specificity. MST (score ≥ 2) resulted in 70.6% sensitivity and 69.5% specificity, AUC 0.77.
  
  
  CONCLUSIONS
  Both the MST and the automated method fell short of the accepted professional standard for sensitivity (~≥ 80%) derived from the PG-SGA. Further investigation into other automated nutrition screening options and the most appropriate parameters available electronically is warranted to support targeted service provision.
authors.affiliation: Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia, Jessica.Abbott@health.qld.gov.au.
authors.forename: J
authors.initials: J
authors.lastname: Abbott
authors.forename: L
authors.initials: L
authors.lastname: Teleni
authors.forename: D
authors.initials: D
authors.lastname: McKavanagh
authors.forename: J
authors.initials: J
authors.lastname: Watson
authors.forename: A
authors.initials: A
authors.lastname: McCarthy
authors.forename: E
authors.initials: E
authors.lastname: Isenring
mesh_terms: D000553:Ambulatory Care; D001331:Automation; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000209:etiology*; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology*; D015596:Nutrition Assessment; D009752:Nutritional Status; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D015431:Weight Loss