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Clinical nutrition, enteral and parenteral nutrition

Validation of the spinal nutrition screening tool (SNST) in patients with spinal cord injuries (SCI): result from a multicentre study

European Journal of Clinical Nutrition volume 66, pages 382–387 (2012)Cite this article

Abstract

Background/Objectives:

A disease-specific nutrition screening tool (NST): the spinal nutrition screening tool (SNST) has been developed for use in patients with spinal cord injury (SCI) but its reliability and agreement with other published tools requires investigation. The aims of this study were to assess the prevalence of malnutrition risk in SCI patients and to confirm the diagnostic accuracy of the SNST.

Subjects/Methods:

Patients’ baseline clinical data, anthropometric measurements and NST scores were assessed. The validity of the SNST was assessed by (i) comparing with a full dietetic assessment (criterion validity); (ii) comparison with a generic NST: malnutrition universal screening tool (MUST) (concurrent validity); and (iii) completion of an additional SNST to assess inter- and intra-rater reliability. Agreement was assessed using Cohen's κ-statistics.

Results:

Using the SNST, the prevalence of malnutrition risk ranged from 22 to 64% on admission to four SCI centres. The SNST had substantial agreement with MUST (κ: 0.723, 95% confidence interval (CI): 0.607–0.839) and dietitian assessment (κ: 0.567, 95% CI: 0.434–0.699). The SNST had a moderate to substantial reliability (inter-rater reliability: κ: 0.5, 95% CI: 0.2–0.8; intra-rater reliability: κ: 0.64, 95% CI: 0.486–0.802). When compared with dietetic assessment, the SNST had a numerically lower specificity (76.1% vs 80.4%) and similar agreement to MUST (κ: 0.57 vs 0.58) but SNST showed a numerically higher sensitivity (85.7% vs 80.4%) and a numerically higher negative predictive value (92% vs 89.2%) than MUST.

Conclusions:

This study shows that malnutrition is common in SCI patients. The SNST is an acceptable (valid and reliable) NST and may be a useful alternative to MUST in identifying SCI patients at risk of malnutrition.

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Acknowledgements

We thank the patients who consented to participate in the study. We would also like to thank the effort done by the consultant and nursing staff at the participating centres, Dr Joan Gandy (The British Dietetics Association), Dr Helen Dolls (University of Oxford) and Professor John Reilly (University of Glasgow) for protocol development. Lindsay Wood and Lynsey Spillman for reviewing the paper, Anthony Twist (Robert Jones and Agnes Hunt Orthopaedic and District Hospital), Philippa Bearne (Salisbury District Hospital), Dr Angela Gall, Prof Michael Cragg and Judith Susser (Royal National Orthopaedic Hospital) for data collection. This project was partly funded by an unrestricted grant from Abbott Nutrition. University College London (UCL) Staff receive support from the Comprehensive Biomedical Research Centre funding awarded to UCL and its partner Trust by National Institute of Health and Research.

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Authors and Affiliations

  1. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK

    S Wong, F Derry & A Jamous

  2. Centre of Gastroenterology and Clinical Nutrition, University College London, London, UK

    S Wong, G Grimble & A Forbes

  3. School of Community and Health Science, City University, London, UK

    S P Hirani

Authors
  1. S Wong
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  2. F Derry
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  3. A Jamous
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Corresponding author

Correspondence to S Wong.

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The authors declare no conflict of interest.

Additional information

Part of the study data were presented at the Nutrition Society annual meeting in July 2011 at University of Reading, UK and International Spinal Cord Society annual meeting in June 2011.Contributors: SW—protocol development, data collection, data analysis, manuscript preparation. FD—protocol development, clinical supervision, manuscript revision. AJ—clinical supervision, manuscript revision. SPH—statistical supervision, manuscript revision. GG—Academic supervision, manuscript revision. AF—Academic supervision, manuscript revision.

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Wong, S., Derry, F., Jamous, A. et al. Validation of the spinal nutrition screening tool (SNST) in patients with spinal cord injuries (SCI): result from a multicentre study. Eur J Clin Nutr 66, 382–387 (2012). https://doi.org/10.1038/ejcn.2011.209

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