Preoperative nutritional screening tools in adults for malnutrition:
                                                                                                                                                                                   1          1              1
                                                                                                                                                          Hoi Ting Helen CHEUNG , Anna LEE , Gavin JOYNT
                    a systematic review                                                                                1
                                                                                                                        Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong
          Introduction                                 Objective                          Methods
         Patients with malnutrition are                To assess the accuracy            We searched MEDLINE, EMBASE, CINAHL and Web of Science (any language, from date of inception to 24 Feb 2022) for potential studies. We 
         at higher risk of adverse                     of commonly used                  included observational studies reporting the accuracy of a pre-specified nutritional index tests against a reference standard (Subjective Global 
         outcomes after exposure to                    nutritional screening             Assessment [SGA]). Seven index tests were included: Malnutrition Screening tool (MST), Malnutrition Universal Screening Tool (MUST), Mini 
         surgery. Numerous nutritional                 tools for identifying             Nutritional Assessment (MNA), short-form Mini Nutritional Assessment (MNA-SF), Nutritional Risk Index (NRI), Nutrition Risk Screening Tool 2002 
         screening tools for identifying               preoperative                      (NRS-2002) and Preoperative Nutrition Screening (PONS). Two reviewers independently assessed methodological quality using the Quality 
         malnourished patients are                     malnutrition in adults            Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.1 Study characteristics and 2×2 accuracy data from cross‐tabulated results of index 
         available but there is no                     undergoing elective               tests and SGA were being extracted. MetaDTA and Stata 17.0 were used to construct a random‐effects bivariate binomial model to pool sensitivity 
         international consensus on                    surgery.                          and specificity from included studies for each type of index nutritional screening tool.2
         which is the best tool. 
          Results                                                                                                       Index test    Studies (patients)   Sensitivity (95% CI)   Specificity (95% CI)     +LR (95% CI)           -LR (95% CI)         DOR (95% CI)
         Of 13 studies involving 4796                                                                                   MNA                1 (136)           89.3  (71.8 - 97.7)    83.3 (74.9 - 89.8)    5.36 (3.45 -8.33)     0.13  (0.04 - 0.38)  41.7 (11.4 - 152.9)
         participants with 9052 index and SGA 
         tests, the risk of bias in 1 study was                                                                         MNA-SF             3 (1279)          73.5  (68.5 - 78.0)    81.9 (79.3 - 84.2)    4.06  (3.49 – 4.71)   0.32  (0.27 – 0.39)    12.5 (9.3 - 16.9)
         low, 3 at moderate and 9 at high 
         (mainly because of lack of blinded                                                                             MUST               7 (2753)          88.8  (72.8 - 95.9)    91.0  (87.9 - 93.3)  9.84  (7.41 - 13.07)   0.12  (0.05 - 0.32)  79.7 (28.6 - 222.3)
         assessments of tests). Mean prevalence 
         of preoperative malnutrition across all                                                                        NRI                6 (735)           84.7  (69.4 – 93.1)   62.6  (46.3 – 76.4)    2.26  (1.59 – 3.23)   0.24 (0.13 - 0.47)     9.3 (4.3 - 19.9)
         studies ranged from 18% (MNA-SF) to 
         40% (PONS). Compared to other index 
         tests, MUST had the highest test                                                                               NRS-2002          11 (3443)          76.4  (58.7 - 88.1)    91.3  (85.6 - 94.8)  8.74  (5.95 - 12.85)   0.26 (0.14 - 0.47)    33.8 (20.0 - 57.3)
         accuracy performance characteristics. 
         (Table 1, Figure 1)                                                                                            PONS               1 (706)           47.0  (41.1 - 53.0)    93.3  (90.5 - 95.5)  7.07  (4.84 - 10.32)   0.57 (0.51 - 0.64)     12.5 (8.0 - 19.5)
          Conclusion                                                                                                   Table 1. Sensitivity, specificity and Likelihood Ratios Derived by Index Tests (Abbreviations: +LR = positive likelihood Ratio; -LR = 
                                                                                                                       negative likelihood Ratio; DOR = diagnostic odds ratio
         Preoperative malnutrition is common.                                                                                                                                                                          Ms. Helen Hoi Ting Cheung          ORCID ID:
         MUST shows the highest test accuracy                                                                           References                                                                  Department of Anesthesia and Intensive Care
         performance. Further assessment and                                                                            1.Whiting PF, et al.  J Clin Epidemiol 2013;66:1093-104.                             The Chinese University of Hong Kong 
         nutritional counseling to optimize pre-                                                                                                                                                          Email: helenhtcheung@link.cuhk.edu.hk
         operative preparation for surgical                     Figure 1.  Random-effects meta-analysis - MUST          2. Chu H et al. J Clin Epidemiol. 2006;59:1331-2.                                                  Phone: +852 3505 2087
         patients are needed.
         Conflict of Interest Disclosure: Nil