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Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults†

  • Rebecca J. Stratton (a1), Annemarie Hackston (a1), David Longmore (a1), Rod Dixon (a1), Sarah Price (a1), Mike Stroud (a1), Claire King (a1) and Marinos Elia (a1)
  • DOI: http://dx.doi.org/10.1079/BJN20041258
  • Published online: 01 March 2007
Abstract

The ‘malnutrition universal screening tool’ (‘MUST’) for adults has been developed for all health care settings and patient groups, but ease of use and agreement with other published tools when screening to identify malnutrition requires investigation. The present study assessed the agreement and the prevalence of malnutrition risk between ‘MUST’ and a variety of other tools in the same patients and compared the ease of using these tools. Groups of patients were consecutively screened using ‘MUST’ and: (1) MEREC Bulletin (MEREC) and Hickson and Hill (HH) tools (fifty gastroenterology outpatients); (2) nutrition risk score (NRS) and malnutrition screening tool (MST; seventy-five medical inpatients); (3) short-form mini nutritional assessment (MNA-tool; eighty-six elderly and eighty-five surgical inpatients); (4) subjective global assessment (SGA; fifty medical inpatients); (5) Doyle undernutrition risk score (URS; fifty-two surgical inpatients). Using ‘MUST’, the prevalence of malnutrition risk ranged from 19–60% in inpatients and 30% in outpatients. ‘MUST’ had ‘excellent’ agreement (κ 0.775–0.893) with MEREC, NRS and SGA tools, ‘fair–good’ agreement (κ 0.551–0.711) with HH, MST and MNA-tool tools and ‘poor’ agreement with the URS tool (κ 0.255). When categorisation of malnutrition risk differed between tools, it did not do so systematically, except between ‘MUST’ and MNA-tool (P=0.0005) and URS (P=0.039). ‘MUST’ and MST were the easiest, quickest tools to complete (3–5 min). The present investigation suggested a high prevalence of malnutrition in hospital inpatients and outpatients (19–60% with ‘MUST’) and ‘fair–good’ to ‘excellent’ agreement beyond chance between ‘MUST’ and most other tools studied. ‘MUST’ was quick and easy to use in these patient groups.

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Corresponding author
*Corresponding author: Dr Rebecca J. Stratton, fax +44 23 80794945, email, R.J.Stratton@soton.ac.uk
Footnotes
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Some of the results have been presented as abstracts at meetings of the British Association for Parenteral and Enteral Nutrition (BAPEN) and the European Society of Parenteral and Enteral Nutrition (ESPEN). For more information and for a free download of the malnutrition universal screening tool and the explanatory booklet, see www.bapen.org.uk

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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

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AS Detsky , JR McLaughlin , JP Baker , N Johnston , S Whittaker , RA Mendelson & KN Jeejeebhoy (1987) What is subjective global assessment of nutritional status?. J Parenter Enteral Nutr 11, 813.

MP Doyle , E Barnes & M Moloney (2000) The evaluation of an undernutrition risk score to be used by nursing staff in a teaching hospital to identify surgical patients at risk of malnutrition on admission: a pilot study. J Hum Nutr Diet 13, 433441.

M Hickson & M Hill (1997) Implementing a nutritional assessment tool in the community: a report describing the process, audit and problems encountered. J Hum Nutr Diet 10, 373377.

CL King , M Elia , MA Stroud & RJ Stratton (2003) The predictive validity of the malnutrition universal screening tool (‘MUST’) with regard to mortality and length of stay in elderly inpatients. Clin Nutr 22 S4

J Kondrup , SP Allison , M Elia , B Vellas & M Plauth (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22, 415421.

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SJ Lewis , M Egger , PA Sylvester & S Thomas (2001) Early enteral feeding versus ‘nil by mouth’ after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. Br Med J 323, 773776.

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LZ Rubenstein , JO Harker , A Salva , Y Guigoz & B Vellas (2001) Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A 56, M366M372.

RJ Stratton , R Dixon , D Longmore , M Stroud & M Elia (2003 a) Effect of recalled weight and height on malnutrition risk. Clin Nutr 22, Suppl. 1 S9

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British Journal of Nutrition
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  • EISSN: 1475-2662
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