The Reliability and Validity of Patient-Generated Subjective Global Assessment (PG-SGA) in Stroke Patients

뇌졸중 환자에서 '환자 주도적 총체적 영양사정' 도구의 신뢰도 및 타당도 평가

  • Yoo, Sung-Hee (Clinical Specialist in Stroke Center, Asan Medical Center.College of Nursing, Yonsei University) ;
  • Oh, Eui-Guem (College of Nursing, Yonsei University) ;
  • Youn, Mi-Jung (Neurology Department, Asan Medical Center)
  • 유성희 (서울아산병원 임상전문(뇌졸중).연세대학교 간호대학원) ;
  • 오의금 (연세대학교 간호대학원) ;
  • 윤미정 (서울아산병원 신경계병동)
  • Received : 2009.08.24
  • Accepted : 2009.12.01
  • Published : 2009.12.31

Abstract

Purpose: This study was to examine the reliability and validity of Patient-Generated Subjective Global Assessment (PG-SGA) as a nutritional measurement for stroke patients. Methods: This was a methodological study performed from May 6 to June 10, 2009 at a tertiary university hospital in Seoul. For reliability of PG-SGA, inter-rater reliability was used for statistics. For concurrent validity, BMI and biomarkers were compared between PG-SGA 0 ~ 8 and ${\geq}$ 9. In addition, sensitivity, specificity, and predictive value of PG-SGA compared with SGA were calculated using a contingency table. For predictive validity, hospital day, complications, and readmission within 1-month after discharge were compared between PG-SGA 0 ~ 8 and ${\geq}$ 9. Results: Correlation of PG-SGA score between two observers was 0.83, and kappa value for the agreement of severe malnutrition was 0.78(all $p_s$ < .001). The scored PG-SGA showed high sensitivity and specificity (100% and 96.7%, respectively). Severe undernourished patients (PG-SGA ${\geq}$ 9) had significantly low TLC, protein, albumin, and prealbumin (all $p_s$ < .01) compared with non-undernourished patients (PG-SGA 0 ~ 8). Also, in severe undernourished patients, complications and readmission (all $p_s$ = 0.01) were more often represented, and hospital days (p = .013) were significantly delayed. Conclusion: PG-SGA is a reliable and valid measurement to assess nutritional status for stroke patients.

Keywords

References

  1. Atalay, B. G., Yagmur, C., Nursal, T. Z., Atalay, H., & Noyan, T. (2008). Use of subjective global assessment and clinical outcomes in critically ill geriatric patients receiving nutrition support. Journal of Parenteral and Enteral Nutrition, 32(4), 454-459. https://doi.org/10.1177/0148607108314369
  2. Baker, J. P., Detsky, A. S., Wesson, D. E., Wolman, S. L., Stewart, S., Whitewell, J., Langer, B., & Jeejeebhoy, K. N. (1982). Nutritional assessment: A comparison of clinical judgement and objective measurements. The New England Journal of Medicine, 306(16), 969-972. https://doi.org/10.1056/NEJM198204223061606
  3. Bauer, J., Capra, S., & Ferguson, M. (2002). Use of the scored Patient-Generated Subjective Global Assessment(PG-SGA) as a nutrition assessment tool in patients with cancer. European Journal of Clinical Nutrition, 56(8), 779-785. https://doi.org/10.1038/sj.ejcn.1601412
  4. Bistrian, B. R., Blackburn, G. L., Vitale, J., Cochran, D., & Naylor, J. (1976). Prevalence of malnutrition in general medical patients. JAMA: The Journal of the American Medical Association, 235(15), 1567-1570. https://doi.org/10.1001/jama.235.15.1567
  5. Covinsky, K. E., Covinsky, M. H., Palmer, R. M., & Sehgal, A. R. (2002). Serum albumin concentration and clinical assessments of nutritional status in hospitalized older people: Different sides of different coins? Journal of the American Geriatrics Society, 50(4), 631-637. https://doi.org/10.1046/j.1532-5415.2002.50156.x
  6. Curtas, S., Chapman, G., & Meguid, M. M. (1989). Evaluation of nutritional status. The Nursing Clinics of North America, 24(2), 301-313.
  7. Davalos, A., Ricart, W., Gonzalez-Huix, F., Soler, S., Marrugat, J., Molins, A., Suner, R., & Genis, D. (1996). Effect of malnutrition after acute stroke on clinical outcome. Stroke, 27(6), 1028-1032.
  8. Davis, J. P., Wong, A. A., Schluter, P. J., Henderson, R. D., O'Sullivan, J. D., & Read, S. J. (2004). Impact of premorbid undernutrition on outcome in stroke patients. Stroke, 35(8), 1930-1934. https://doi.org/10.1161/01.STR.0000135227.10451.c9
  9. Detsky, A. S., McLaughlin, J. R., Baker, J. P., Johnston, N., Whittaker, S., Mendelson, R. A., & Jeejeebhoy, K. N. (1987). What is subjective global assessment of nutritional status? Journal of Parenteral and Enteral Nutrition, 11(1), 8-13. https://doi.org/10.1177/014860718701100108
  10. Foley, N. C., Salter, K. L., Robertson, J., Teasell, R. W., & Woodbury, M. G. (2009). Which reported estimate of the prevalence of malnutrition after stroke is valid? Stroke, 40, e66-e74. https://doi.org/10.1161/STROKEAHA.108.518910
  11. FOOD Trial Collaboration (2003). Poor nutritional status on admission predicts poor outcomes after stroke: Observational data from the FOOD trial. Stroke, 34(6), 1450-1456. https://doi.org/10.1161/01.STR.0000074037.49197.8C
  12. Gariballa, S. E., Parker, S. G., Taub, N., & Castleden, C. M. (1998). Influence of nutritional status on clinical outcome after acute stroke. The American Journal of Clinical Nutrition, 68(2), 275-281.
  13. Haas, M. (2009). Nutritional assessment. Contemporary issues in lung cancer (pp.161-164). Jones & Bartlett Publishers.
  14. Isenring, E., Cross, G., Daniels, L., Kellett, E., & Koczwara, B. (2006). Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy. Supportive Care in Cancer, 14(11), 1152-1156. https://doi.org/10.1007/s00520-006-0070-5
  15. Lipkin, E. W., & Bell, S. (1993). Assessment of nutritional status. The clinician's perspective. Clinics in Laboratory Medicine, 13(2), 329-352.
  16. Martineau, J., Bauer, J. D., Isenring, E., & Cohen, S. (2005). Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients. Clinical Nutrition, 24(6), 1073-1077. https://doi.org/10.1016/j.clnu.2005.08.010
  17. Munro, B. H., & Page, E. B. (1993). Statistical methods for health care research (2nd ed.). Philadelphia: Lippincott.
  18. Ottery, F. D. (1996). Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition, 12(1 Suppl), S15-19.
  19. Persson, C., Sjoden, P. O., & Glimelius, B. (1999). The Swedish version of the patient-generated subjective global assessment of nutritional status: Gastrointestinal vs urological cancers. Clinical Nutrition, 18(2), 71-77. https://doi.org/10.1016/S0261-5614(99)80054-5
  20. Potter, J., Klipstein, K., Reilly, J. J., & Roberts, M. (1995). The nutritional status and clinical course of acute admissions to a geriatric unit. Age and Ageing, 24(2), 131-136. https://doi.org/10.1093/ageing/24.2.131
  21. Unosson, M., Ek, A. C., Bjurulf, P., von Schenck, H., & Larsson, J. (1994). Feeding dependence and nutritional status after acute stroke. Stroke, 25(2), 366-371.
  22. Wakahara, T., Shiraki, M., Murase, K., Fukushima, H., Matsuura, K., Fukao, A., Kinoshita, S., Kaifuku, N., Arakawa, N., Tamura, T., Iwasa, J., Murakami, N., Deguchi, T., & Moriwaki, H. (2007). Nutritional screening with Subjective Global Assessment predicts hospital stay in patients with digestive diseases. Nutrition, 23(9), 634-639. https://doi.org/10.1016/j.nut.2007.06.005
  23. Yoo, S. H., Kim, J. S., Kwon, S. U., Yun, S. C., Koh, J. Y., & Kang, D. W. (2008). Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients. Archives of Neurology, 65(1), 39-43. https://doi.org/10.1001/archneurol.2007.12