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Background: Malnutrition is a widely well-recognised prevalent and complex condition in adult patients. Despite the prevalence of malnutrition being extensively studied in Australian metropolitan hospitals, the true burden of malnutrition is not fully understood in rural and remote settings. The objectives of this study were to describe the burden of malnutrition in a large remote Central Australian hospital and validate the use of a reliable screening tool to detect malnutrition in acute adult patients.
Methods: This is a cross-sectional study of patients admitted to a remote Australian hospital from 2014 – 2023. Using convenience sampling, Aboriginal Australian and non-Aboriginal adult patients aged 18 years and over admitted into the Emergency Department or inpatient ward setting were invited to participate in the study. Participants were screened for malnutrition risk using the Malnutrition Screening Tool (MST ≥2) or the Adult Nutrition Tool (ANT ≥3). Participants classified ‘at risk’ of malnutrition with a MST ≥2 or ANT ≥4 or under the care of a dietitian underwent malnutrition assessment and classification using the Subjective Global Assessment (SGA) tool. Participants with a SGA of B or C were classified as malnourished. The validity of the ANT across inpatient wards was evaluated using a cut-off score of ≥2 and ≥3 in comparison to the MST utilising validated cut-off score ≥2 in participants with a completed SGA.
Results: Of the 980 study participants, 70.1% identified as Aboriginal Australian. The mean age of participants was 54.4 years, and 42.6% were identified at risk of malnutrition using the MST ≥2 or ANT ≥3. A total of 374 participants received a SGA based on a positive malnutrition risk score (MST ≥2 or ANT ≥4), or who were under the care of a dietitian. The proportion of malnutrition in participants who were classified at risk of malnutrition was 58.8%. Utilising the ANT, the area under the curve was higher (0.738, 95% CI 0.67 - 0.81) when compared to the MST (0.642, 95% CI 0.56 - 0.73). An ANT ≥2 demonstrated overall higher sensitivity (98.2%) and a lower false negative rate (1.8%) than a ANT score of ≥3 (8.0%) or MST score ≥2 (2.8%).
Conclusion: The potential burden of malnutrition is high in remote Australian hospitals when compared to regional or metropolitan hospitals, reiterating the importance of prevention and management within this vulnerable population. This study validated both the ANT and MST as an accurate and reliable tool for identifying Aboriginal and non-Aboriginal patients at risk of malnutrition, with a suggested ‘at risk’ score of greater than or equal to 2 when utilising the ANT |
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