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Application of subjective global assessment as a screening tool for malnutrition in pediatric surgical patients.

OBJECTIVES
To determine the incidence of malnutrition in the pediatric surgical ward and to evaluate the value of SGA as a nutrition assessment tool in this patient group.


PATIENTS AND METHOD
Consecutive pediatric patients aged 2 months-16 years who were admitted for an operation in the pediatric surgical ward, Songklanagarind Hospital from February to September 2001 were included. Nutritional assessment was performed for each case, using a translated version of the SGA questionnaire. Anthropometric measurements and laboratory tests were performed as a routine pre-operative evaluation. The result of the SGA ratings were tested against the other parameters and Gomez's weight for age (W/A) criteria for protein energy malnutrition. SGA and the other parameters were tested for association with post-operative infectious complications. Each SGA question was analyzed by multivariate logistic regression analysis, to determine an independent correlation between the question item and final SGA rating.


RESULTS
The study included 78 patients. At least one item of SGA history was positive in 28 cases (35.9%). The SGA rating was class A in 50 cases (64.1%), class B in 17 cases and class C in 11 cases. According to the Gomez classification, 42 cases (53.8%) were considered normal or overweight, whereas 23 cases (29.5%) were in the first degree underweight, 9 cases were in the second degree and 4 cases were in the third degree. Malnutrition by SGA rating correlated significantly with Gomez's second and third degree malnutrition, lower z-score, lower BMI and hypoalbuminemia. Malnutrition by SGA rating and hypoalbuminemia were associated with increased risk of an infectious complication, whereas a significant relation between a complication and anthropometric malnutrition could not be demonstrated. Moreover, SGA malnutrition was significantly associated with a longer post-operative stay. Among 5 items of SGA questions, history of weight change in the recent 2 weeks and increased energy need considered by an underlying disease were found to be independently associated with a final SGA rating of malnutrition. History of weight loss and gastrointestinal symptoms were the 2 most sensitive questions.


CONCLUSIONS
SGA is a sensitive and specific nutrition assessment tool useful in a pre-operative pediatric setting. Application of the protocol as a complement of standard anthropometric tool should be considered.