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ClinicalNutrition(2003)22(4):415–421r2003ElsevierLtd.Allrightsreserved.doi:10.1016/S0261-5614(03)00098-0SPECIALARTICLEESPENGuidelinesforNutritionScreening2002J.KONDRUP,nS.P.ALLISON,yM.ELIA,zB.VELLAS,zM.PLAUTHynRigshospitaletUniversityHospitalCopenhagen,Denmark,yQueen’sMedicalCentre,Nottingham,UK,zUniversityofSouthampton,Southampton,UK,zUniversityHospitalCentre,Toulouse,France,yCommunityHospitalDessau,Germany(Correspondenceto:JK,NutritionUnit^5711,RigshospitaletUniversity,9Blegdamsvej,2100Copenhagen,Denmark)Abstract3Aim:Toprovideguidelinesfornutritionriskscreeningapplicabletodi¡erentsettings(community,hospital,elderly)basedonpublishedandvalidatedevidenceavailableuntilJune2002.Note:Theseguidelinesdeliberatelymakereferencetotheyear2002intheirtitletoindicatethatthisversionisbasedontheevidenceavailableuntil2002andthattheyneedtobeupdatedandadaptedtocurrentstateofknowledgeinthefuture.InordertoreachthisgoaltheEducationandClinicalPracticeCommitteeinvitesandwelcomesallcriticismandsugges-tions(buttonformailtoECPCchairman).r2003ElsevierLtd.Allrightsreserved.Keywords:NutritionalAssessment;malnutrition;hos-pital;communityBackgroundAbout30%ofallpatientsinhospitalareunder-nourished.Alargepartofthesepatientsareunder-nourishedwhenadmittedtohospitalandinthemajorityofthese,undernutritiondevelopsfurtherwhileinhospital(1).Thiscanbepreventedifspecialattentionispaidtotheirnutritionalcare.Otherfeaturesofthepatient’sprimarydiseasearescreenedroutinelyandtreated(e.g.dehydration,bloodpressure,fever),anditisunacceptablethatnutritionalproblemscausingsignificantclinicalriskarenotidentified.Neglectisalsobeginningtohavemedico-legalconsequences,sinceanincreasingnumberofcasesofnutritionalneglectarebeingbroughttothecourts.Thereiseveryreason,therefore,forhospitalsandhealthcareorganizationstoadoptaminimumsetofstandardsinthisarea.However,thelackofawidelyacceptedscreeningsystemwhichwilldetectpatientswhomightbenefitclinicallyfromnutritionalsupportiscommonlyseenasamajorlimitingfactortoimprovement.Itisthepurposeofthisdocumenttogivesimpleguidelinesastohowundernutrition,orriskfordevelop-mentofundernutrition,canbedetected,byproposingasetofstandardswhicharepracticableforgeneraluseinpatientsandclientswithinpresenthealthcareresources.PurposeofscreeningThepurposeofnutritionalscreeningistopredicttheprobabilityofabetterorworseoutcomeduetonutritionalfactors,andwhethernutritionaltreatmentislikelytoinfluencethis.Outcomefromtreatmentmaybeassessedinanumberofways:1.Improvementoratleastpreventionofdeteriorationinmentalandphysicalfunction2.Reducednumberorseverityofcomplicationsofdiseaseoritstreatment.3.Acceleratedrecoveryfromdiseaseandshortenedconvalescence.4.Reducedconsumptionofresources,e.g.lengthofhospitalstayandotherprescriptions.Thenutritionalimpairmentidentifiedbyscreeningshouldthereforeberelevanttotheseaimsandoutcomesandmayvaryaccordingtocircumstances,e.g.ageortypeofillness.Inthecommunity,undernutrition,withorwithoutchronicdisease,maybetheprimaryfactordeterminingthementalorphysicalfunctionofanindividual,whereasinhospitalorinanursinghome,diseasefactorsassumeagreaterimportancewithdisease-associatedundernutritionassuminganimportantalbeitsecondaryrole.Screeninginthecommunitycanthereforebefocusedprimarilyonnutritionalvariablesbasedontheresultsofsemi-starvationstudiessuchasthoseofAncelKeysandhiscolleaguesin1950(2).Inhospitals,otheraspectsofdiseaseneedtobeconsideredincombinationwithpurelynutritionalmeasurementsinordertodeter-minewhethernutritionalsupportislikelytobebeneficial.Randomizedcontrolledtrialsofnutritionalsupportinparticulardiseasegroupsmaythereforeprovideimportantevidenceonwhichtobaseourcriteriaofnutritionalrisk.MethodologicalconsiderationsTheusefulnessofscreeningtoolscanbeevaluatedbyanumberofmethods.Thepredictivevalidityisofmajorimportance,i.e.thattheindividualidentifiedtobeat415riskbythemethodislikelytoobtainahealthbenefitfromtheinterventionarisingfromtheresultsofthescreening.Thiscanbeobtainedinvariousways,asdescribedfortheindividualscreeningtoolsbelow.Thescreeningtoolmustalsohaveahighdegreeofcontentvalidity,i.e.consideredtoincludeallrelevantcomponentsoftheproblemitismeanttosolve.Thisisusuallyachievedbyinvolvingrepresentativesofthosewhoaregoingtouseitintheprocessofdesigningthetool.Itmustadditionallyhaveahighreliability,i.elittleinter-observervariation.Itmustalsobepractical,i.e.thosewhoaregoingtousethetoolmustfinditrapid,simpleandintuitivelypurposeful.Itshouldnotcontainredundantinformation,e.g.informationaboutvomitingordysphagiaisunnecessarywhendietaryintakeispartofthescreening.Theetiologyofreduceddietaryintakebelongstoasssessment(seebelow)orisincorporatedintothenutritioncareplan.Severalotheraspectsofevaluatingscreeningtoolsaredescribedinananalysisof44nutritionalscreeningtools(3).Finally,ascreeningtoolshouldbelinkedtospecifiedprotocolsforaction,e.g.referralofthosescreenedatrisktoanexpertformoredetailedassessmentandcareplans.ScreeningleadstonutritionalcareHospitalandhealthcareorganizationsshouldhaveapolicyandaspecificsetofprotocolsforidentifyingpatientsatnutritionalri