Malnutrition in Elderly Trauma Patients - Comparison of Two Assessment Tools

• Published in: Zeitschrift fur Orthopadie und Unfallchirurgie Vol. 155; no. 2; p. 184
• Main Authors: Ihle, C, Bahrs, C, Freude, T, Bickel, M, Spielhaupter, I, Wintermeyer, E, Stollhof, L, Grünwald, L, Ziegler, P, Pscherer, S, Stöckle, U, Nussler, A
• Format: Journal Article
• Language: German
• Published: Germany 01-04-2017
• Subjects: Aged; Aged, 80 and over; Causality; Comorbidity; Diagnosis, Differential; Female; Geriatric Assessment - methods; Geriatric Assessment - statistics & numerical data; Germany - epidemiology; Humans; Male; Malnutrition - diagnosis; Malnutrition - epidemiology; Middle Aged; Nutrition Assessment; Nutritional Status; Prevalence; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Wounds and Injuries - diagnosis; Wounds and Injuries - epidemiology
• ISSN: 1864-6743
• DOI: 10.1055/s-0042-116822

The prevalence of malnutrition in hospitalised patients is reported to be between 16 and 55 % across disciplines. Within hospital care, screening for malnutrition is required. However, in orthopaedics and trauma surgery, there is still no generally accepted recommendation for the methods for such a data survey. In the present study, the following aspects are to be investigated with the help of two established scores: (1) the prevalence of malnutrition in the patient population of geriatric trauma care, and (2) the correlation between methods of data survey.
Between June 2014 and June 2015, a consecutive series of hospitalised trauma patients were studied prospectively with two validated screening instruments to record nutritional status. The study was carried out at a municipal trauma surgery hospital, which is a first level interregional trauma centre as well as a university hospital. The Nutritional Risk Screening (NRS) and the Mini Nutritional Assessment (MNA Short and Long Form) were used. All patients were divided into three age groups: < 65 years, 65-80 years, and > 80 years. The prevalence of malnutrition in geriatric trauma patients and the correlation between the screening instruments were determined. For a better comparison, prescreening and main assessment were applied to all patients. For statistical evaluation, both quantitative and semi-quantitative parameters were used. Furthermore, the Kolmogorov-Smirnov test, Spearman's correlation analysis and the chi-square test were applied. These tests were two-sided and had a level of significance of 5 %. The present study was partially funded by the Oskar-Helene-Heim Foundation.
521 patients (43.8 % women, 56.2 % men), with a mean age of 53.96 ± 18.13 years, were statistically evaluated within the present study. Depending on the method of the data survey, malnutrition (NRS≥3) in geriatric trauma patients varied from 31.3 % (65-80 years) to 60 % (> 80 years). With MNA, 28.8 and 54.3 % of patients were at risk of malnutrition (MNA 17-23.5), while the fractions of patients already suffering from malnutrition (MNA < 17) were 5.4 and 8.6 %, respectively. The correlation between the NRS and MNA total scores increases with the age of the patients. The correlation coefficient for patients under 65 years is r = - 0.380, while among patients aged between 65 and 80, it is r = - 0.481, and for patients over 80 years, there is a medium to strong correlation of r = - 0.638 (each with a Spearman correlation of p < 0.001). For the total population as well as the different age groups, statistically significant correlations were recorded between the categorised scores (chi-square test for linear trend, p < 0.001).
The present study demonstrates high prevalence of malnutrition among the geriatric trauma patients. Because of its easy and rapid application, the NRS has an advantage in clinical use. It was shown that the two methods of data survey were highly correlated.