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Clinical Nutrition

Validity and reliability of the new Canadian Nutrition Screening Tool in the ‘real-world’ hospital setting

European Journal of Clinical Nutrition volume 69, pages 558–564 (2015)Cite this article

Subjects

Abstract

Background/Objectives:

Nutrition screening should be initiated on hospital admission by non-dietitians. This research aimed to validate and assess the reliability of the Canadian Nutrition Screening Tool (CNST) in the ‘real-world’ hospital setting.

Subjects/Methods:

Adult patients were admitted to surgical and medical wards only (no palliative patients). Study 1—Nutrition Care in Canadian Hospitals (n=1014): development of the CNST (3 items: weight loss, decrease food intake, body mass index (BMI)) and exploratory assessment of its criterion and predictive validity. Study 2—Inter-rater reliability and criterion validity assessment of the tool completed by untrained nursing personnel or diet technician (DT) (n=150). Subjective Global Assessment performed by site coordinators was used as a gold standard for comparison.

Results:

Study 1: The CNST completed by site coordinators showed good sensitivity (91.7%) and specificity (74.8%). Study 2: In the subsample of untrained personnel (160 nurses; one DT), tool’s reliability was excellent (Kappa=0.88), sensitivity was good (>90%) but specificity was low (47.8%). However, using a two-item (‘yes’ on both weight change and food intake) version of the tool improved the specificity (85.9%). BMI was thus removed to promote feasibility. The final two-item tool (study 1 sample) has a good predictive validity: length of stay (P<0.001), 30-day readmission (P=0.02; X2 5.92) and mortality (P<0.001).

Conclusions:

The simple and reliable CNST shows good sensitivity and specificity and significantly predicts adverse outcomes. Completion by several untrained nursing personnel confirms its utility in the nursing admission assessment.

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Acknowledgements

We are grateful for the support of the 18 hospitals (also 3 of these sites for study 2) and the site coordinators who collected the data.

Author information

Authors and Affiliations

  1. Clincal Nutrition Department, Vitalité Health Network, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada

    M Laporte

  2. Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada

    H H Keller

  3. Research Center on Aging, Health and Social Services Centre, University Institute of Geriatrics of Sherbrooke, University of Sherbrooke, Sherbrooke, Québec, Canada

    H Payette

  4. Department of Medicine, University Hospital Network, University of Toronto, Toronto, Ontario, Canada

    J P Allard & A Teterina

  5. Department of Medicine, St-Boniface Hospital, University of Manitoba, Winnepig, Manitoba, Canada

    D R Duerksen

  6. Jewish General Hospital, Montréal, Québec, Canada

    P Bernier

  7. Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada

    K Jeejeebhoy

  8. Department of Medicine, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada

    L Gramlich

  9. Canadian Malnutrition Task Force, Canadian Nutrition Society, Toronto, Ontario, Canada

    B Davidson

  10. University of Guelph, Guelph, Ontario, Canada

    E Vesnaver

Authors
  1. M Laporte
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Corresponding author

Correspondence to M Laporte.

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Competing interests

All authors declare financial support from the Canadian Nutrition Society (CNS), which funded the research with unrestricted grants from Abbott Nutrition, Nestle Health Science, Baxter, Fresenius Kabi and Pfizer. ML, HHK, HP, JPA, DRD, PB, KJ and LG are also members of Abbott Nutrition speaker bureau. HHK and JPA have received honoraria for chairing the Canadian Malnutrition Task Force from the CNS.

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Laporte, M., Keller, H., Payette, H. et al. Validity and reliability of the new Canadian Nutrition Screening Tool in the ‘real-world’ hospital setting. Eur J Clin Nutr 69, 558–564 (2015). https://doi.org/10.1038/ejcn.2014.270

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