C.P. van der Schans

SUN-PP209: Dutch Patient-Generated Subjective Global Assessment (PG-SGA): Training Improves Scores for Comprehensibility and Difficulty

Rationale: The Patient-Generated Subjective Global Assessment (PG-SGA) is a validated instrument to assess and monitor malnutrition, which consists of both patient-reported and professional-reported items. A professional should be able to correctly interpret all items. Untrained professionals may experience difficulty in completing some items of the PG-SGA. We aimed to explore the change in perceived comprehensibility and difficulty of the Dutch PG-SGA by health care professionals on the use of the instrument, before and after training.nMethods: A sample of 36 untrained health care professionals, of which 34 dietitians, completed a set of 29 items on a four point scale regarding comprehensibility and difficulty of the PG-SGA on two separate occasions: nT0) two weeks before and T1) directly after an instructional session on the PG-SGA and training with the physical exam. Summarized comprehensibility indexes (SCI) and difficulty indexes (SDI) were calculated for the patient part of the PG-SGA (aka PG-SGA Short Form; PG-SGA SF), the professional part of the PG-SGA (PG-SGApro) and the full PG-SGA, to quantify the level of perceived comprehensibility and difficulty. SCI≥0.80 and SDI≥0.80 were considered acceptable, SCI≥0.90 and SDI≥0.90 were considered excellent.nResults: SCI of the PG-SGA SF was acceptable both before (SCI: 0.80) and after training (SCI: 0.89). SCI of the nPG-SGApro and full PG-SGA changed from unacceptable (SCI: 0.64; 0.69) to excellent (SCI: 0.95; 0.94). nAll SDIs changed from unacceptable (SDI for respectively PG-SGA SF, PG-SGApro and full PG-SGA: 0.71; 0.50; 0.57) to acceptable (SDI: 0.88; 0.85; 0.87).nConclusion: Training professionals in the use of the PG-SGA can be an effective strategy for improving the level of both comprehensibility and difficulty.

Nutritional assessment 2MON-P195: Diagnostic Accuracy of ESPEN Diagnostic Criteria for Malnutrition in Selected Clinical Populations

Submission Identifier: ESPEN17-ABS-1516 DIAGNOSTIC ACCURACY OF ESPEN DIAGNOSTIC CRITERIA FOR MALNUTRITION IN SELECTED CLINICAL POPULATIONS P. Dewansingh*, 1, 2, L. ter Beek 1, 3, 4, M. Euwes 5, G. van der Sluis 6, F. D. Ottery 1, 7, C. P. van der Schans 1, 8, 9, 10, H. Jager-Wittenaar 1, 11 1Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, 2 Nutrition and dietetics, Nij Smellinghe Hospital, Drachten, 3Department of Pulmonary Diseases and Tuberculosis, Center for Rehabilitation, 4Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, 5General Health care , 6Department of Physical Therapy, Nij Smellinghe Hospital, Drachten, Netherlands, 7 Ottery & Associates, Vernon Hills (Chicago), United States, 8Faculty of Medical Sciences, 9Dept. of Rehabilitation Medicine, 10 Dept. of Health Psychology Research, 11Dept. of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands Presentation Method: Oral or Poster presentation Please indicate your professional occupation: Other The presenting author fulfills the above conditions and wants to apply for a travel award: No The presenting author fulfills the above conditions and wants to apply for the ESPEN Prize: No Rationale: We aimed to assess diagnostic accuracy of ESPEN’s Diagnostic Criteria for malnutrition (EDC), as compared to the Patient-Generated Subjective Global Assessment (PG-SGA) in selected clinical populations. Methods: In two hospitals, in 174 patients (67.5±10.3 yrs; COPD: n=116; colon/rectum cancer: n=21; orthopedic: n=37) malnutrition was assessed by EDC and PG-SGA. According to EDC, malnutrition was defined as having at least one of the following criteria: 1) BMI <18.5 kg/m2; 2) combination of unintentional weight loss (>10% of habitual weight indefinite of time, or >5% over 3 months) and low BMI (<20 or <22 kg/m2 in subjects younger and older than 70 yrs, respectively) and/or a low fat-free mass index (FFMI) by bio-electrical impedance (<15 [female] and <17 kg/m2 [male]). As reference, malnutrition was defined as PGSGA Stage B (moderately/suspected malnutrition) or Stage C (severely malnourished). Diagnostic accuracy was assessed by sensitivity, specificity, positive and negative predictive value, and ROC curve. Results: According to EDC and PG-SGA, 6.9% and 31% were malnourished, respectively. For COPD, colon/rectum cancer, and orthopedic patients, prevalence was 9.5% and 39.7%, 4.8% and 19%, and 0% and 10.8% respectively. Overall sensitivity, specificity, positive and negative predictive value were 0.15, 0.97, 0.85 and 0.03, respectively. The area under the ROC curve (AUC) was 0.56 (p=0.23) for the total population. For COPD, colon/rectum cancer, and orthopedic patients AUC was 0.55 (p=0.39), 0.63 (p=0.45), and 0.50 (p=1.00), respectively. Conclusion: In COPD, rectum-/colon cancer, and orthopedic patients, diagnostic accuracy of EDC as compared to the PG-SGA is low, especially sensitivity and negative predictive value. Consequently, using EDC in these populations is likely to result in underrecognition of malnutrition, which may hinder timely and adequate treatment of malnutrition. Disclosure of Interest: P. Dewansingh: None Declared, L. ter Beek: None Declared, M. Euwes: None Declared, G. van der Sluis: None Declared, F. Ottery Other: Developer of the PG-SGA, co-developer of the PG-SGA based Pt-Global app, C. van der Schans: None Declared, H. Jager-Wittenaar Other: Co-developer of the PG-SGA based Pt-Global app