Malnutrition risk assessment by the adapted malnutrition universal screening tool and its relation to clinical outcomes in patients after acute stroke

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Malnutrition risk assessment by the adapted malnutrition universal screening tool and its relation to clinical outcomes in patients after acute stroke

 

Author: Chan, Shuk-sum Susanne
Title: Malnutrition risk assessment by the adapted malnutrition universal screening tool and its relation to clinical outcomes in patients after acute stroke
Degree: M.Sc.
Year: 2011
Subject: Hong Kong Polytechnic University -- Dissertations
Malnutrition -- Risk assessment -- China -- Hong Kong
Cerebrovascular disease -- Nutritional aspects -- China -- Hong Kong
Cerebrovascular disease -- Patients -- Care -- China -- Hong Kong
Department: School of Nursing
Pages: viii, 90 leaves : ill. ; 30 cm.
InnoPac Record: http://library.polyu.edu.hk/record=b2412259
URI: http://theses.lib.polyu.edu.hk/handle/200/5973
Abstract: Background: Patients after stroke are at particular risk of malnutrition as a result of functional loss and higher level of dependency. However, the problem of malnutrition is under-recognized. Poor nutrition in stroke patients leads to increased mortality and morbidity. A rapid, non-invasive and reliable screening tool would improve the identification of patients at risk of malnutrition and enable timely intervention that gives rise to better clinical outcomes. The "Malnutrition Universal Screening Tool" which possesses these characteristics has been adapted and validated in the local Chinese population recently. Its potential use in stroke patients and ability to relate to clinical outcomes require investigations. Objectives: The objectives of this study are: (1) to assess the malnutrition risk in patients admitted into an acute stroke unit by using the Adapted Malnutrition Universal Screening Tool (A-MUST); (2) to identify demographic and clinical characteristics that are associated with malnutrition risk after acute stroke; (3) to examine the relationship between malnutrition risk on admission and clinical outcomes including functional dependency and hypoalbuminemia at 1 month after stroke; (4) to identify factor(s) that predict(s) poor clinical outcomes including functional dependency and hypoalbuminemia at 1 month after stroke. Design: A prospective descriptive study. Main outcome measures: Functional dependency at 1 month (modified Rankin Scale ≥ 3) and hypoalbuminemia at 1 month (serum albumin level < 32 g/L). Method: Patients admitted into an acute stroke unit in a regional hospital in Hong Kong who met the sampling criteria were recruited to the study. Baseline data including the demographic characteristics, clinical variables and nutritional variables for each patient were collected. Individual’s risk of malnutrition was evaluated by A-MUST within 3 days of admission (T1). The A-MUST comprised 3 components: Body Mass Index, unplanned weight loss percentage and acute disease effect score which categorized patients into 3 levels of malnutrition risk. Functional outcomes and serum albumin level were measured at 1 month (T2). Results: From February to October 2010, 84 stroke patients were screened by the Adapted Malnutrition Universal Screening Tool. 54.8% of patients had low risk of malnutrition, 27.4% had medium risk and 17.9% had high risk. Age, premorbid residency and premorbid functional dependency were associated with the risk of malnutrition. Patients at high risk of malnutrition had significantly greater NIHSS mean score, lower CMMSE mean score and serum albumin level at baseline. Malnutrition risk on admission was significantly associated with functional dependency and hypoalbuminemia at 1 month after stroke. Malnutrition risk, stroke severity and cognitive function predicted functional dependency at 1 month after stroke. Cognitive function predicted hypoalbuminemia at 1 month after stroke. Conclusion: There is a high prevalence of malnutrition risk in patients after acute stroke as determined by the Adapted Malnutrition Universal Screening Tool. Malnutrition risk on admission is associated with poor clinical outcomes after acute stroke, and it predicts functional dependency at 1 month after stroke. The results suggest that early nutritional screening is important and A-MUST has the ability to predict poor clinical outcomes after stroke. Abbreviations: NIHSS, National Institutes of Health Stroke Scale; CMMSE, Chinese Mini Mental State Examination.

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