Elsevier

Nutrition

Volumes 67–68, November–December 2019, 110529
Nutrition

Applied nutritional investigation
Nutritional self-screening in <1 min: Evaluation of a measuring station using sonic measurement of height

https://doi.org/10.1016/j.nut.2019.06.010Get rights and content

Highlights

  • A device with sonic height measurement was adapted for nutritional self-screening.

  • Gastrointestinal outpatients found self-screening user friendly and rapid (36 s).

  • Agreement between self-screening and health professional screening was excellent.

  • Studies in the laboratory and in healthy individuals confirmed device validity.

  • The automated electronic procedures minimise transcription and calculation errors.

Abstract

Objective

Since nutritional screening is not routinely and accurately performed by busy care workers, the aim of this study was to evaluate a self-screening electronic measuring station that includes sonic height measurements.

Methods

In all, 114 patients, 18 to 85 y of age and attending gastrointestinal outpatient clinics, followed automatically triggered audio-recorded instructions for weight and height measurements. The patients also provided information about unintentional weight loss to establish malnutrition risk using the Malnutrition Universal Screening Tool (MUST). In 56 healthy individuals, the effect of head/foot positions on height was examined using video-recordings. Laboratory studies examined the effects of hair/wigs, the position of a skull and horizontal plates and ambient conditions. Measurements were also made on a mechanical machine for comparison.

Results

Of the patients, 21.9% were malnourished, with 99% agreement between sonic and mechanical machine categorization. Patients self-screened in only 35.6 ± 14.8 s (median 32 s) and 77% rated the screening as very easy (22%, easy), despite encountering some remediable snags. Within-subject precision for height was 0.186 cm in healthy individuals and 0.368 cm in patients. Humidity and barometric pressure had negligible/undetectable effects on height measurements, but temperature corrections were confounded by calibration errors. In the most lateral standing positions, height was underestimated curvilinearly. In healthy individuals, height measurements were 0.353 ± 0.542 cm lower on the sonic than mechanical device, which was inadequately explained by standing position or body tilt, although hair was found to be “invisible” only to the sonic machine.

Conclusion

A method has been developed to rapidly and reliably self-screen for malnutrition using MUST, avoiding calculation and categorization errors, while providing results that can be immediately printed or transmitted electronically into patient notes.

Introduction

Although nutritional screening is recommended in various care settings, malnutrition remains underrecognized and undertreated. This is problematic because malnutrition adversely affects well-being, predisposes to disease, delays recovery from illness, and increases disease complications, at immense cost to social and health care services [1]. A reason why recommended nutritional screening is not performed routinely is that it is not a high enough priority among busy care workers (professionals such as doctors and nurses and/or assistants such as nurse assistant), which means that they may miss malnutrition [2], [3]. Another reason [4] is that certain screening tools are time-consuming, not linked to care plans, and subject to calculation or categorization errors. Self-administered questionnaires can be valuable, but they typically lack objective measurements of weight, height, and body mass index (BMI), which are cornerstones of many nutrition screening tools. Self-screening using automated processes and a valid, reliable tool linked to care may overcome such difficulties [3]. Self-screening studies of hospital outpatients [5], [6], [7] showed that reproducible and accurate results could be obtained quickly using the Malnutrition Universal Screening Tool (MUST) [3]. One such study [7], using a modified digital weight and height machine with electronic transmission of results to a computer, reported self-screening in 1.29 min. It suggested considerably faster screening could occur if height was measured sonically, obviating the need to lower a horizontal plate over the head. However, sonic measurements can be confounded by ambient temperature and head position relative to the sonic emitter(s) and sensor(s). The purpose of this study was to critically evaluate a device with sonic technology, with respect to accuracy, reproducibility, user friendliness, and suitability for routine nutritional self-screening. In addressing this issue, the accuracy of height and BMI measurements were assessed, and results of MUST categorization obtained on the sonic machine were compared with those on a mechanical machine.

Section snippets

General

Unless otherwise stated, all sonic (40 kHz) height measurements of plates/skull and calibration bar (see later) were made at 19°C to 22°C, barometric pressure 101 to 104 kPA and humidity 40% to 60%, vertically above the central point of the horizontal standing platform. This point was defined as the midpoint of the rectangular area [16.5 cm (width) × 15 cm (depth)] enclosing two small footmarks. To ensure stable positions during measurements, the plates/skull were supported by wide vertical

Instrument tilt

The column of the sonic machine (∼213 cm) was tilted 0.6 cm to the left and 0.7 cm to the back (left and back referring to participant position during routine measurement). The midpoint of the middle two sensors/emitters was vertically above a point 0.6 cm to the left and 1.75 cm behind the central point of the standing platform.

Precision (reproducibility) and accuracy

On the sonic device, reference weights (0–160 kg) weighed only 0.003 ± 0.022 (SD) kg (0.003% ± 0.021%) more than the values attributed to them. The height of the 81.5

Discussion

This study found that patients can reliably and accurately self-screen for malnutrition using a device that simultaneously measures height sonically and weight, with automated calculation of BMI, weight loss, and malnutrition categories. A series of studies also identified the strengths and limitation of the device.

Conclusion

This study of ambulatory patients, involving self-screening using sonic height measurements, paves the way toward electronically assisted screening of malnutrition risk in routine practice. The procedure avoids calculation and categorization errors and produces results for almost immediate printing or electronically transmission into patient notes. Self-screening in the community (e.g., general practices and pharmacies) could help prevent malnutrition or facilitate early treatment.

Acknowledgments

The authors acknowledge the clinic staff for their support, Seca for information about its devices, and D Turville for programming for automation.

References (7)

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Cited by (4)

  • General practitioners’ views on malnutrition management and oral nutritional supplementation prescription in the community: A qualitative study

    2020, Clinical Nutrition ESPEN
    Citation Excerpt :

    A recent study in The Netherlands using two online screening tools found that approximately 57% of community-living older adults were at risk of malnutrition, thus, concluding that this easy access online screening could be useful to reach older adults at nutritional risk and could therefore, contribute to early identification and prevention [41]. Another recently published study by Elia et al. used a device with sonic height measurement for nutritional self-screening of gastrointestinal outpatients, finding excellent agreement between HCPs screening and self-screening [42]. NICE guidelines recommend the use of ONS in the case of patients at risk of malnutrition or who are already malnourished [35].

This study was made possible by the University of Southampton and the National Health Service (NHS), which allowed the study to be undertaken as a service delvelopment by staff already employed by these organisations, without financial support from external funding agencies.Conception and design of the study: ME conceived of and designed the study and was responsible for generation and assembly of the study results, as well as analysis and interpretation of the data. ME, AC, TS, and TA collected the data. ME, AC, TS drafting and revised the manuscript and approved the final version of the manuscript.

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