title: Assessing nutrition in the critically ill elderly patient: A comparison of two screening tools.
abstract: BACKGROUND
  Few malnutrition screening tests are validated in the elderly Intensive Care Unit (ICU) patient.
  
  
  OBJECTIVE
  Having previously established malnutrition as a cause of higher mortality in this population, we compared two screening tools in elderly patients.
  
  
  METHODS
  For this prospective study, 111 consecutive patients admitted to the ICU and > 65 years underwent the Malnutrition Universal Screening Tool (MUST), and the Geriatric Nutrition Risk Index (GNRI) screening tests.
  
  
  METHODS
  Standard definition of malnutrition risk was taken as the gold standard to evaluate the sensitivity, specificity and predictive values of the tools. The k statistic was calculated to measure the agreement between the tools. The Shrout classification was used to interpret its values.
  
  
  RESULTS
  The mean age of the patients screened was 74.7 ± 8.4 (65-97 years). The standard definition, MUST and GNRI identified 52.2%, 65.4%, and 64.9% to be malnourished, respectively. The sensitivity and specificity of the tests were 96.5% computed tomography (CI) (87.9-99.5%) and 72.3% CI (57.5-84.5%) for MUST and 89.5% CI (75.2-96.7%) and 55.0% CI (75.2-96.9%) for GNRI, respectively. Screening was not possible by GNRI and MUST tool in 31% versus 4% of patients, respectively. The agreement between the tools was moderate for Standard-MUST k = 0.65 and MUST-GNRI k = 0.60 and fair for Standard-GNRI k = 0.43.
  
  
  CONCLUSIONS
  The risk of malnutrition is high among our patients as identified by all the tools. Both GNRI and MUST showed a high sensitivity with MUST showing a higher specificity and greater applicability.
authors.affiliation: Department of Trauma and Emergency Medicine (Critical Care), All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
authors.forename: Swagata
authors.initials: S
authors.lastname: Tripathy
authors.affiliation: Department of Anaesthesia, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
authors.forename: J C
authors.initials: JC
authors.lastname: Mishra
keywords: Critical care outcome; elderly critically ill; malnutrition; nutrition screening tools