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Nutrition in acute and chronic diseases

Application of NRS2002 to detect malnutrition in a tertiary care centre: agreement between nurse and dietician’s screening steps and relation with clinical outcomes

European Journal of Clinical Nutrition volume 77, pages 692–697 (2023)Cite this article

Subjects

Abstract

Objective

To evaluate the agreement between nurse and dietician nutritional risk assessments when using the Nutritional Risk Screening 2002 (NRS2002) protocol, and to explore the relations of falsely labeling patients ‘not at risk‘ for malnutrition and the screening time difference (STD) between nurse and dietician with the length of stay (LoS).

Methods

Included are all patients hospitalized in a tertiary care center between January 2017 and December 2019 and screened for malnutrition by both a nurse and a dietician. The inter-rater reliability is evaluated using Cohen’s Kappa. The relation between STD and the patient classification (PCET) is assessed by a linear mixed effect model. The relation between the LoS and PCET is evaluated with the Kaplan–Meier method and multivariable Cox regression including STD with pathology group and severity of illness as random effect.

Results

9085 patients are assessed by nurse and dietician. 72% of all assessments agree (Kappa = 0.44 [0.43–0.46]). The dietician is involved later for patients falsely labeled ‘not at risk’ (1.06 [0.92–1.20] days; p < 0.001). Compared to patients where the dietician is involved within 3 days, the LoS is 7.37 days (Hazard Ratio (HR): 0.51 [0.43–0.61]) longer for patients falsely labeled ‘not at risk’, while only 3.51 days (HR: 0.72 [0.64–0.80]) longer for patients correctly labeled ‘at risk’.

Conclusions

Agreement of screening for malnutrition between nurses and dieticians is weak. Avoiding falsely labeling patients ‘not at risk‘ should be a main concern upon patient admission as later involvement of dieticians is correlated with a longer LoS.

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Fig. 1: Selection and screening protocol. only patients screened by both nurse and dietician are included.
Fig. 2: Distribution by a boxplot of the LoS by PCET, square = mean LoS.

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Data availability

The datasets analyzed during the current study are not publicly available due to patient level data of which combination of the variables can lead to identify patients.

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Author information

Authors and Affiliations

  1. Data Science Institute, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Ghent, Belgium

    Mieke Deschepper

  2. Nursing Department, Ghent university Hospital, Corneel Heymanslaan 10, 9000 Gent, Ghent, Belgium

    Veerle Duprez

  3. Department of Endocrinology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Ghent, Belgium

    Bruno Lapauw

  4. Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Bruno Lapauw

  5. Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium

    Kristof Eeckloo

  6. Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Ghent, Belgium

    Kristof Eeckloo

  7. Centre for Healthy food and dietetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Ghent, Belgium

    Sophie Marchand

Authors
  1. Mieke Deschepper
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Contributions

MD: Conceptualization; Data curation; Formal analysis; Methodology; Visualization; Writing—original draft. SM: Conceptualization; Methodology; Resources; Validation; Data curation; Writing—review & editing. VD: Methodology; Validation; Writing—original draft. BL: Conceptualization; Supervision; Writing—review & editing. KE: Supervision; Writing—review & editing.

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Correspondence to Mieke Deschepper.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by the ethics committee at Ghent University Hospital (Belgian registration no. BC-09757).

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Deschepper, M., Duprez, V., Lapauw, B. et al. Application of NRS2002 to detect malnutrition in a tertiary care centre: agreement between nurse and dietician’s screening steps and relation with clinical outcomes. Eur J Clin Nutr 77, 692–697 (2023). https://doi.org/10.1038/s41430-023-01281-z

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