title: Validity and reliability of the new Canadian Nutrition Screening Tool in the 'real-world' hospital setting.
abstract: OBJECTIVE
  Nutrition screening should be initiated on hospital admission by non-dietitians. This research aimed to validate and assess the reliability of the Canadian Nutrition Screening Tool (CNST) in the 'real-world' hospital setting.
  
  
  METHODS
  Adult patients were admitted to surgical and medical wards only (no palliative patients). Study 1--Nutrition Care in Canadian Hospitals (n=1014): development of the CNST (3 items: weight loss, decrease food intake, body mass index (BMI)) and exploratory assessment of its criterion and predictive validity. Study 2--Inter-rater reliability and criterion validity assessment of the tool completed by untrained nursing personnel or diet technician (DT) (n=150). Subjective Global Assessment performed by site coordinators was used as a gold standard for comparison.
  
  
  RESULTS
  Study 1: The CNST completed by site coordinators showed good sensitivity (91.7%) and specificity (74.8%). Study 2: In the subsample of untrained personnel (160 nurses; one DT), tool's reliability was excellent (Kappa=0.88), sensitivity was good (>90%) but specificity was low (47.8%). However, using a two-item ('yes' on both weight change and food intake) version of the tool improved the specificity (85.9%). BMI was thus removed to promote feasibility. The final two-item tool (study 1 sample) has a good predictive validity: length of stay (P<0.001), 30-day readmission (P=0.02; X(2) 5.92) and mortality (P<0.001).
  
  
  CONCLUSIONS
  The simple and reliable CNST shows good sensitivity and specificity and significantly predicts adverse outcomes. Completion by several untrained nursing personnel confirms its utility in the nursing admission assessment.
authors.affiliation: Clincal Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Laporte
authors.affiliation: Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: H H
authors.initials: HH
authors.lastname: Keller
authors.affiliation: Research Center on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, University of Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Payette
authors.affiliation: Department of Medicine, University Hospital Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: J P
authors.initials: JP
authors.lastname: Allard
authors.affiliation: Department of Medicine, St-Boniface Hospital, University of Manitoba, Winnepig, Manitoba, Canada.
authors.forename: D R
authors.initials: DR
authors.lastname: Duerksen
authors.affiliation: Jewish General Hospital, Montréal, Québec, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Bernier
authors.affiliation: Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Jeejeebhoy
authors.affiliation: Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Gramlich
authors.affiliation: Canadian Malnutrition Task Force, Canadian Nutrition Society, Toronto, Ontario, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Davidson
authors.affiliation: University of Guelph, Guelph, Ontario, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Vesnaver
authors.affiliation: Department of Medicine, University Hospital Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Teterina
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002170:Canada; D004435:Eating; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D015203:Reproducibility of Results; D015431:Weight Loss; D055815:Young Adult