Sains Malaysiana 45(9)(2016): 1311–1317

Re-evaluation of Malnutrition Risk Screening Tool-Hospital (MRST-H) for Geriatric Patients: A Multicentre Study in Peninsular Malaysia

(Penilaian Semula Alat Penyaringan Risiko Malpemakanan Hospital (MRST-H) untuk

Pesakit Geriatrik: Kajian Pelbagai Pusat di Semenanjung Malaysia)

TAN SZE LIN¹, SAKINAH HARITH^1*, HASMAH ABDULLAH² & WAN NAZIRAH

WAN YUSUF³

¹Dietetics Programme, School of Health Sciences, Health Campus, Universiti Sains Malaysia

16150 Kubang Kerian, Kelantan Darul Naim, Malaysia

²Environmental and Occupational Health Programme, School of Health Sciences, Health Campus

Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Darul Naim, Malaysia

³Department of Pharmacology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Darul Naim, Malaysia

Received: 19 November 2015/Accepted: 22 April 2016

ABSTRACT

A local Malnutrition Risk Screening Tool-Hospital (MRST-H) has been developed to identify the risk of malnutrition among hospitalized geriatric patients in Malaysia. The aims of this multicenter study were to evaluate the criterion validity of the MRST-H against the reference standard Subjective Global Assessment (SGA) and revise its scoring criteria among Malaysian geriatric patients. A cross-sectional study was conducted among 542 geriatric patients at eight general hospitals in Peninsular Malaysia from January 2011 to February 2013. The Malay version MRST-H and SGA were administered to all participants through face-to-face interviews. Sensitivity and specificity of MRST-H were established using the Receiver Operating Characteristic (ROC) curves and the optimal cut-off scores were determined. The MRST-H had area under the ROC curve (AUC) values of 0.84 and 0.88 when validated against the SGA-determined malnutrition (SGA B+C) and severe malnutrition (SGA C) status. These high AUC values indicated that the MRST-H has very good overall diagnostic accuracy. However, the original cut-off score of five points for MRST-H has undesirable sensitivity in identifying the malnutrition (sensitivity = 0.12) and severely malnutrition (sensitivity = 0.35) status. The optimal cut-off score of MRST-H in identifying malnourished and severely malnourished participants were both established at the cut-off score of two points. The sensitivity of MRST-H increased substantially at this point without compromising its specificity. Therefore, the established cut-off score of two points with optimal sensitivity and specificity was selected to replace to original cut-off score for screening of risk of malnutrition among hospitalized geriatric patients.

Keywords: Geriatric patients; malnutrition; MRST-H; nutritional screening; validity

ABSTRAK

Suatu alat Penyaringan Risiko Malpemakanan-Hospital (MRST-H) tempatan telah dibangunkan untuk mengenal pasti risiko malpemakanan dalam kalangan pesakit dalam wad dan pesakit luar geriatrik di beberapa hospital di Malaysia. Tujuan kajian pelbagai pusat ini adalah untuk menilai kesahihan kriteria MRST-H terhadap piawai rujukan Penilaian Subjektif Global (SGA) dan menyemak semula kriteria pemarkahannya dalam kalangan pesakit geriatrik di Malaysia. Suatu kajian keratan rentas telah dijalankan dalam kalangan 542 orang pesakit geriatrik di lapan buah hospital Semenanjung Malaysia dari Januari 2011 hingga Februari 2013. Soal selidik MRST-H dan SGA versi Bahasa Melayu telah dijawab oleh semua peserta melalui temu bual bersemuka. Kepekaan dan kekhususan MRST-H diketahui melalui lengkung Penerima Operasi Sifat (ROC) dan markah titik optimum juga ditentukan melaluinya. MRST-H mempunyai kawasan di bawah lengkung ROC (AUC) sebanyak 0.84 dan 0.88 apabila disahkan terhadap status malpemakanan (SGA B+C) dan malpemakanan teruk (SGA C). Nilai AUC yang tinggi ini menunjukkan bahawa MRST-H mempunyai ketepatan diagnostik keseluruhan yang sangat baik. Walau bagaimanapun, markah titik asal MRST-H (skor lima) mempunyai kepekaan yang tidak diingini dalam mengenal pasti status malpemakanan (kepekaan = 0.12) dan malpemakanan teruk (kepekaan=0.35). Kedua-dua markah titik optimum MRST-H dalam mengenal pasti peserta yang mengalami malpemakanan dan malpemakanan teruk adalah pada skor dua. Kepekaan MRST-H meningkat dengan ketara tanpa menjejaskan kekhususannya pada markah ini. Oleh itu, markah titik skor dua yang mempunyai kepekaan dan spesifikasi optimum telah dipilih untuk menggantikan markah titik asal untuk penyaringan risiko malpemakanan dalam kalangan pesakit geriatrik di hospital.

Kata kunci: Malpemakanan; MRST-H; pengesahan; penyaringan pemakanan; pesakit geriatrik

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*Corresponding author; email: sakinah_harith@usm.my