Use of self-administered Malnutrition Universal Screening Tool (MUST) is not a valid means of identifying inpatients at risk for malnutrition on the Clinical Teaching Unit

Background: Evidence exists validating self-administration of the Malnutrition Universal Screening Tool (MUST) to screen for risk of malnutrition among outpatients, but the validity of self-screening by inpatients has not yet been demonstrated. The goal of this study was to determine the validity of self-screening with the MUST as a means of identifying inpatients at risk for malnutrition. Methods: Audits of all patients admitted to the London Health Sciences clinical teaching units (CTU) were conducted over a 5-day period in 2015. Patients eligible for participation provided signed consent. Patients screened themselves using the MUST before the health care provider (HCP) (who was blind to the patient’s self-screen results) did. Each participant completed an ease-of-use questionnaire. Results: 125 hospitalized patients were considered for enrolment, of which 65.6% (82/125) were excluded on the basis of a cognitive impairment or a physical impediment that prohibited informed consent or safe participation, respectively. A total of 17 inpatients (13.6%) were enrolled, ten of who completed the MUST and generated a risk score. Agreement between self-screening and HCP-screening was 70%. Conclusion: Owing to the cognitive and physical impairments among the CTU population, self-screening using MUST is neither a practical nor safe means of identifying those at risk for malnutrition. AUTHOR CONFLICT OF INTEREST STATEMENT AND INFORMATION  The author declares no conflict of interest  Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada. 2 Lawson Health Research Institute, London, Ontario, Canada. Program of Experimental Medicine, Western University Department of Medicine.  Corresponding Author Adam Rahman, MD MSc (EPID) FRCPC, Assistant Professor of Medicine, Division of Gastroenterology, Western University adam.rahman@sjhc.london. on.ca, 268 Grosvenor St. London, Ontario, N6A 4V2, Room B0-689, St. Joseph's Health Centre  © Rahman et. al. This is an open access journal distributed under the terms of the Creative Common License BY NC Introduction The negative impacts of malnutrition on hospitalized patients have been well documented across 40 years of literature (1-5). Despite this evidence, malnutrition continues to be overlooked, under-diagnosed, and largely untreated leading to malnutrition rates ranging from 2060% (1,4,6-10). A recent Canadian study found malnutrition rates of 57% amongst inpatients admitted to the London Health Sciences Centre (LHSC) clinical teaching units (CTUs), and of these patients 4% had been screened for malnutrition (6). Screening tools, such as the Malnutrition Universal Screening Tool (MUST), can generate scores that correspond with low, medium, or high risk for malnutrition (11,12). The MUST has been validated to detect malnutrition in inpatient and outpatient settings, as well as being a reliable predictor of length-of-stay and mortality in elderly patients (13,14). Given the time constraints on healthcare providers (HCP), empowering patients to screen themselves for malnutrition is an appealing proposition. Previous work has demonstrated the efficacy of patients self-administering the MUST to screen for malnutrition in a variety of outpatient environments (13,15). The goal of this study was to determine the validity of self-screening with the MUST as a means of identifying inpatients at risk for malnutrition on the acute medicine unit. CLINICAL RELEVANCY STATEMENT  We attempt to determine if patients admitted to hospital can determine their own nutritional risk score using the Malnutrition Universal Screening Tool.  Cognitive and physical impairments made self-directed screening impractical