Screening tool IDs patients at risk for malnutrition

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Malnutrition in surgical patients raises mortality rates, readmissions and poor outcomes while also reducing recovery time and quality of life. Researchers at Johns Hopkins Hospital (JHH) in Baltimore have published a study in The Annals of Thoracic Surgery evaluating a new screening tool capable of identifying patients at risk for malnutrition.

Using the JHH Nutrition Score, researchers hope to provide clinicians with a tool to easily identify at-risk patients. The score uses markers like white blood cell count, operation status and prior interventions to be highly predictable and easy to calculate.

"Days in the ICU can go by quickly before we realize patients are not getting the nutritional support they need to improve recovery," said senior author Glenn Whitman, MD, of Johns Hopkins Hospital. "The nutrition risk score may heighten our sensitivity to patients who are most at risk for needing nutritional support, allowing them to receive intervention sooner than we might have done in the past."

The study enrolled 1,056 open-heart surgery patients to test the JHH Nutrition Score and results found 87, or 8 percent, of patients required postoperative nutritional support. Patients who had diabetes and chronic obstructive pulmonary disease were more at risk than others.

"The JHH risk score can be used as a screening tool to divide cardiac surgery admissions into low or high risk for needing nutrition support," said Dr. Whitman. "By adding up the total point score, we can look at patients and determine how at risk they are for being unable to eat during the initial ICU period. If the patients are at high risk, and we know that, we can start nutrition sooner. In using the JHH Nutrition Score to accurately identify the at-risk patients and then aggressively pursuing nutrition support, we may improve substantially upon their current poor outcomes. Individualized nutrition strategies, combined with the expertise of the nutrition support team and the clinical approach of the caregiver, may further enhance the management of these patients."