Background
Malnutrition may worsen clinical outcomes in stroke
patients. Few malnutrition screening tools have been validated in the
rehabilitation setting. The present study aimed to assess the concurrent
and predictive validity of two malnutrition screening tools.
Methods
We retrospectively collected scores for the Mini Nutritional
Assessment Short‐Form (MNA‐SF) and the Geriatric Nutritional Risk Index
(GNRI) in consecutive stroke patients aged ≥65 years in a
rehabilitation hospital. Concurrent validity was confirmed against the
European Society for Clinical Nutrition and Metabolism diagnostic
criteria for malnutrition (ESPEN‐DCM). Malnutrition risk within the
ESPEN‐DCM process was assessed using the Malnutrition Universal
Screening Tool. Cut‐off values with maximum Youden index, and with
sensitivity (Se) >90% and specificity (Sp) >50%, were defined as
appropriate for identification and screening of malnutrition,
respectively. The Functional Independence Measure and discharge
destination were used to explore predictive validity.
Results
Overall, 420 patients were analysed. Of these, we included
125 patients in the malnutrition group and 295 in the non‐malnutrition
group based on the ESPEN‐DCM. Cut‐off values for the identification and
screening of malnutrition were 5 (Se: 0.78; Sp: 0.85) and 7 (Se: 0.96;
Sp: 0.57) for the MNA‐SF; 92 (Se: 0.74; Sp: 0.84) and 98 (Se: 0.93; Sp:
0.50) for the GNRI, respectively. The GNRI predicted discharge to acute
care hospital, whereas the MNA‐SF did not predict all outcome measures.
Conclusions
The MNA‐SF and the GNRI have a fair concurrent validity in
stroke patients, although lower cut‐off values than currently used were
required for the MNA‐SF. The GNRI exhibits good predictive validity for
discharge destination.
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