title: Use of the nutritional risk score by surgeons and nutritionists.
abstract: BACKGROUND
  The Nutritional Risk Score (NRS) is a validated tool to identify patients who should benefit of nutritional interventions. Nutritional screening however has not yet been widely adopted by surgeons. Furthermore, the question about reliability of nutritional assessment performed by surgeons is still unanswered.
  
  
  METHODS
  Data was obtained from a recent randomised trial including 146 patients with an NRS ≥3 as assessed by the surgeons. Additional detailed nutritional assessment was performed for all patients by nutritional specialists and entered prospectively in a dedicated database. In this retrospective, surgeons' scoring of NRS and its components was compared to the assessment by nutritionists (considered as gold standard).
  
  
  RESULTS
  Prospective NRS scores by surgeons and nutritionists were available for 141 patients (97%). Surgeons calculated a NRS of 7, 6, 5, 4 and 3 in 2, 8, 38, 21 and 72 patients respectively. Nutritionists calculated a NRS of 6, 5, 4, 3 and 2 in 8, 26, 47, 57, 3 patients, respectively. Surgeons' assessment was entirely correct in 56 patients (40%), while at least the final score was consistent in 63 patients (45%). Surgeons overrated the NRS in 21% of patients and underestimated the score in 29%. Evaluation of the nutritional status showed most of the discrepancies (54%).
  
  
  CONCLUSIONS
  Surgeon's assessment of nutritional status is modest at best. Close collaboration with nutritional specialists should be recommended in order to avoid misdiagnosis and under-treatment of patients at nutritional risk.
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors: Michael
authors: M
authors: Benoit
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors: Fabian
authors: F
authors: Grass
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland. Electronic address: demartines@chuv.ch.
authors: Nicolas
authors: N
authors: Demartines
authors: Department of Endocrinolgy, Diabetology and Metabolism, Unit of Clinical Nutrition, University Hospital CHUV, Lausanne, Switzerland.
authors: Pauline
authors: P
authors: Coti-Bertrand
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors: Markus
authors: M
authors: Schäfer
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors: Martin
authors: M
authors: Hübner
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D006801:Humans; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods; D064686:Nutritionists; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D066231:Surgeons
keywords: Nutritional risk score; Nutritional screening; Perioperative nutrition; Reliability