儿科营养风险筛查与住院时间的关系
2010-03-12 18:14:31   来源：   作者：  评论：0 点击：

　目的：营养风险筛查（NRS）可发现营养不良患者或存在营养不良风险患者。NRS必需能够正确区分能够从营养治疗中获益的患者及不能获益的患者。一种有效的NRS程序是根据与营养风险强烈相关的因素制定的。长期住院患者出现营养不良和营养相关并发症潜在风险增加。发现可能住院时间较长（LOS）患者能够使注册营养师早期介入预防性营养治疗。本研究的目的是采用标准化NRS程序观察长期住院患者与营养风险评分之间的关系。

　　方法：营养风险筛查（NRS）程序经儿科三级护理机构营养伦理委员会批准。患者入院24小时内进行营养风险评分。NRS评分采用标准工具评估营养风险包括下列四个项目：身体指标、呼吸（通气或无），临床（入院诊断）和饮食。每个项目0～3分，最高总分为12分。NRS程序的可信度和效度在可接受范围。回顾性分析了2009年6月到8月期间住院患者的1299份电子病历。入选标准为LOS>24小时和年龄<21岁住院患者。排除新生儿重症监护患儿，器官捐献者和年龄≥21患儿。排除新发糖尿病患者（n=69），因为这些患者营养干预住院时间相对较短。记录中没有NSR评分的病历（n=44）被排除。

　　结果：最终共有1185份病历（男性651份，女性534份）。平均年龄为58.7±68.2个月，中位数为22个月，范围为0～236个月（19.7岁）。平均LOS=5.5±6.5天，中位数为2.0，范围为0～12。线性回归分析显示LOS与NRS评分明显相关（t=9.72，B=0.11，p<0.001）。

　　结论：NRS程序可用于筛查儿科住院患者营养风险。NRS与LOS存在明显相关性提示可通过筛查营养风险NRS预测LOS。虽然营养风险不仅由LOS决定，但长期住院可增加营养相关并发症。根据线性回归，NRS程序每个风险点增加11.74%的LOS。由于NRS评分高的患者通常住院时间较长，注册营养师可治疗或预防营养相关并发症。因此，这些结果增强了NRS程序的效度，通过NRS在住院24小时内发现能够从营养治疗中获益的儿科患者。

Clinical Nutrition Week 2010 Nutrition Practice Abstracts

Abstracts of Distinction

Nutr Clin Pract. 2010 Feb;25(1):95.

P4 - Pediatric Nutrition Risk Screening: Association With Length of Stay

Catherine M. McDonald, PhD, RD, CNSD; Sarah Gunnell, MS, RD, CNSD.

Dietitians, Primary Children's Medical Center, Salt Lake City, UT.

Introduction: Nutrition risk screening (NRS) identifies patients who are, or are at risk of, becoming malnourished. An NRS procedure must correctly separate patients who would benefit from medical nutrition therapy from those who would not according to the presence of factors associated with nutrition risk. A valid NRS procedure is based upon factors most strongly linked to nutrition risk. The potential for malnutrition and nutrition-related complications is increased for patients who experience longer hospitalizations. The identification of patients with potentially longer length of stay (LOS) enables the registered dietitian (RD) to intervene early with preventive medical nutrition therapy. The aim of this study was to determine any association of inpatient LOS with nutrition risk scores assigned using a standardized NRS procedure. Methods: An NRS procedure was developed with IRB approval by RDs at a pediatric tertiary care facility. Scoring of nutrition risk occurred within 24 hours of inpatient admission. The NRS score was determined with a standardized tool by evaluating nutrition risk in four categories: anthopometric, breathing (ventilated or not), clinical (admitting diagnosis), and diet. Zero to 3 risk points were assigned per category with a maximum total score of 12. Face validity and reliability for the NRS procedure were tested and found to be acceptable. A retrospective review of 1299 electronic medical records was conducted for inpatient admissions during June -August 2009. Inclusion criteria were inpatient status, LOS > 24 hours, and age <21 years. Exclusions were admission to newborn intensive care, organ donor status, and age ≥ 21 years. Admissions for new onset diabetes (n = 69) were excluded because of a relatively short inpatient stay with intensive nutrition intervention that is atypical of other diagnoses. Records without documented NSR scores (n = 44) were excluded. Results: Final analysis included 1185 records (male = 651, female = 534). Mean age = 58.7 months±68.2 months, median = 22 months, range 0-236 months (19.7 years). LOS mean = 5.5±6.5 days, median = 3 days, range 1-75 days. The mean NRS score assigned = 2.1±2.1, median = 2.0, range 0-12. A linear regression for the association between LOS and the NRS score was significant (t = 9.72, B = 0.11, p < 0.001). Conclusions: The NRS procedure was developed to screen for nutrition risk in pediatric inpatients. The significant association suggests NRS can be used to predict LOS in the context of screening for nutrition risk. Although nutrition risk does not depend solely on LOS, longer inpatient stays have been documented to contribute to increased nutrition-related complications. According to the linear regression, each risk point assigned using the NRS procedure was associated with an 11.74% increase in LOS. Because patients with higher NRS scores are likely to remain hospitalized for longer periods of time, the RD is able to triage those patients to remediate or prevent nutrition-related complications. Therefore, these results strengthen the validity of the NRS procedure for determining within 24 hours of admission which pediatric patients could benefit from medical nutrition therapy interventions.