Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patients
Undereating is a frequent concern in acute care geriatric settings and is supposed to worsen the outcomes of the underlying diseases, while the quality of nutritional support could be improved. Two consecutive and prospective audits (A and B) with team training over a1 year period investigated the q...
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| Veröffentlicht in: | Clinical nutrition (Edinburgh, Scotland) Scotland), 1999-08, Vol.18 (4), p.233-240 |
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| creator | Bourdel-Marchasson, I. Barateau, M. Sourgen, C. Pinganaud, G. Sallemontaudon, N. Richard-Harston, S. Reignier, B. Rainfray, M. Emeriau, J.P. |
| description | Undereating is a frequent concern in acute care geriatric settings and is supposed to worsen the outcomes of the underlying diseases, while the quality of nutritional support could be improved.
Two consecutive and prospective audits (A and B) with team training over a1 year period investigated the quality of malnutrition recognition and nutritional support and outcomes in immobilized, critically ill elderly subjects. Results: Audit A included 170 patients (86.3±6.1 years old) and audit B, 232 patients (86.3±6.3), respectively 20.6% and 31.4% of the hospitalized population. Misclassifications occurred in A in 54.0% compared to 34.05% in B (
P < 0.001). 32.6% in A versus 86.9% in B adequately received oral supplements (
P = 0.02). Significant risk factors for the adverse outcomes in the combined two audits were: dementia (RR: 1.8, 95%CI: 1.0 to 3.0,
P = 0.04) and dehydration (RR: 2.0, 95%C1:1.0 to 4.1,
P = 0.05) for pressure ulcer incidence; stroke (RR: 8.8, 95%CI: 4.8 to 16.0,
P < 0.001) for pressure ulcer prevalence at discharge; neoplasms (RR: 1.1, 95%CI: 1.0 to 1.2,
P = 0.02) for nosocomial infections; bladder indwelling for urinary tract infections (RR: 4.8, 95%CI: 2.9 to 7.7,
P < 0.001); swallowing problems for pulmonary infections (RR: 5.4, 95%CI: 2.8 to 10.5,
P < 0.001); venous indwelling for septicaemia (RR: 5.4, 95%CI: 1.3 to 23.3,
P = 0.02). However, after adjustment on significant risk factors, the outcome rate was similar in audit B: death rate: A (15.6%), B (14.2%); length of stay: A (17.3±10.4 days), B (17.4±10.0); pressure ulcer incidence: A (26.4%), B (20.2%), (83% were erythema); pressure ulcer prevalence at discharge: A (14.7%), B (10.3%), (40% were erythema); nosocomial infections: A (26.4%), B (19.0%).
The improvement of malnutrition recognition and nutritional support was not followed by aperceptible decrease in adverse outcome rate, this latter being mainly related to the underlying conditions of these critically ill elderly patients. |
| doi_str_mv | 10.1016/S0261-5614(99)80075-2 |
| format | Article |
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Two consecutive and prospective audits (A and B) with team training over a1 year period investigated the quality of malnutrition recognition and nutritional support and outcomes in immobilized, critically ill elderly subjects. Results: Audit A included 170 patients (86.3±6.1 years old) and audit B, 232 patients (86.3±6.3), respectively 20.6% and 31.4% of the hospitalized population. Misclassifications occurred in A in 54.0% compared to 34.05% in B (
P < 0.001). 32.6% in A versus 86.9% in B adequately received oral supplements (
P = 0.02). Significant risk factors for the adverse outcomes in the combined two audits were: dementia (RR: 1.8, 95%CI: 1.0 to 3.0,
P = 0.04) and dehydration (RR: 2.0, 95%C1:1.0 to 4.1,
P = 0.05) for pressure ulcer incidence; stroke (RR: 8.8, 95%CI: 4.8 to 16.0,
P < 0.001) for pressure ulcer prevalence at discharge; neoplasms (RR: 1.1, 95%CI: 1.0 to 1.2,
P = 0.02) for nosocomial infections; bladder indwelling for urinary tract infections (RR: 4.8, 95%CI: 2.9 to 7.7,
P < 0.001); swallowing problems for pulmonary infections (RR: 5.4, 95%CI: 2.8 to 10.5,
P < 0.001); venous indwelling for septicaemia (RR: 5.4, 95%CI: 1.3 to 23.3,
P = 0.02). However, after adjustment on significant risk factors, the outcome rate was similar in audit B: death rate: A (15.6%), B (14.2%); length of stay: A (17.3±10.4 days), B (17.4±10.0); pressure ulcer incidence: A (26.4%), B (20.2%), (83% were erythema); pressure ulcer prevalence at discharge: A (14.7%), B (10.3%), (40% were erythema); nosocomial infections: A (26.4%), B (19.0%).
The improvement of malnutrition recognition and nutritional support was not followed by aperceptible decrease in adverse outcome rate, this latter being mainly related to the underlying conditions of these critically ill elderly patients.</description><identifier>ISSN: 0261-5614</identifier><identifier>EISSN: 1532-1983</identifier><identifier>DOI: 10.1016/S0261-5614(99)80075-2</identifier><identifier>PMID: 10578023</identifier><identifier>CODEN: CLNUDP</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; audit ; Biological and medical sciences ; Comorbidity ; critically ill ; Cross Infection - epidemiology ; Cross Infection - prevention & control ; Eating ; elderly ; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition ; Female ; Humans ; Incidence ; Intensive care medicine ; Length of Stay ; Linear Models ; Male ; Medical Audit ; Medical sciences ; nosocomial infections ; nutritional support ; Nutritional Support - standards ; Nutritional Support - statistics & numerical data ; Outcome Assessment (Health Care) ; Pressure Ulcer - epidemiology ; Pressure Ulcer - prevention & control ; pressure ulcers ; Prospective Studies ; Protein-Energy Malnutrition - classification ; Protein-Energy Malnutrition - diagnosis ; Protein-Energy Malnutrition - therapy ; Risk Factors ; Treatment Outcome</subject><ispartof>Clinical nutrition (Edinburgh, Scotland), 1999-08, Vol.18 (4), p.233-240</ispartof><rights>1999 Harcourt Publishers Ltd</rights><rights>1999 INIST-CNRS</rights><rights>Copyright 1999 Harcourt Publishers Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-6d9f5ff327b4e46b36694bce0f255cd6a91b985f0a9394fba3f2b16c679e5dc13</citedby><cites>FETCH-LOGICAL-c390t-6d9f5ff327b4e46b36694bce0f255cd6a91b985f0a9394fba3f2b16c679e5dc13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0261-5614(99)80075-2$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1981876$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10578023$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bourdel-Marchasson, I.</creatorcontrib><creatorcontrib>Barateau, M.</creatorcontrib><creatorcontrib>Sourgen, C.</creatorcontrib><creatorcontrib>Pinganaud, G.</creatorcontrib><creatorcontrib>Sallemontaudon, N.</creatorcontrib><creatorcontrib>Richard-Harston, S.</creatorcontrib><creatorcontrib>Reignier, B.</creatorcontrib><creatorcontrib>Rainfray, M.</creatorcontrib><creatorcontrib>Emeriau, J.P.</creatorcontrib><title>Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patients</title><title>Clinical nutrition (Edinburgh, Scotland)</title><addtitle>Clin Nutr</addtitle><description>Undereating is a frequent concern in acute care geriatric settings and is supposed to worsen the outcomes of the underlying diseases, while the quality of nutritional support could be improved.
Two consecutive and prospective audits (A and B) with team training over a1 year period investigated the quality of malnutrition recognition and nutritional support and outcomes in immobilized, critically ill elderly subjects. Results: Audit A included 170 patients (86.3±6.1 years old) and audit B, 232 patients (86.3±6.3), respectively 20.6% and 31.4% of the hospitalized population. Misclassifications occurred in A in 54.0% compared to 34.05% in B (
P < 0.001). 32.6% in A versus 86.9% in B adequately received oral supplements (
P = 0.02). Significant risk factors for the adverse outcomes in the combined two audits were: dementia (RR: 1.8, 95%CI: 1.0 to 3.0,
P = 0.04) and dehydration (RR: 2.0, 95%C1:1.0 to 4.1,
P = 0.05) for pressure ulcer incidence; stroke (RR: 8.8, 95%CI: 4.8 to 16.0,
P < 0.001) for pressure ulcer prevalence at discharge; neoplasms (RR: 1.1, 95%CI: 1.0 to 1.2,
P = 0.02) for nosocomial infections; bladder indwelling for urinary tract infections (RR: 4.8, 95%CI: 2.9 to 7.7,
P < 0.001); swallowing problems for pulmonary infections (RR: 5.4, 95%CI: 2.8 to 10.5,
P < 0.001); venous indwelling for septicaemia (RR: 5.4, 95%CI: 1.3 to 23.3,
P = 0.02). However, after adjustment on significant risk factors, the outcome rate was similar in audit B: death rate: A (15.6%), B (14.2%); length of stay: A (17.3±10.4 days), B (17.4±10.0); pressure ulcer incidence: A (26.4%), B (20.2%), (83% were erythema); pressure ulcer prevalence at discharge: A (14.7%), B (10.3%), (40% were erythema); nosocomial infections: A (26.4%), B (19.0%).
The improvement of malnutrition recognition and nutritional support was not followed by aperceptible decrease in adverse outcome rate, this latter being mainly related to the underlying conditions of these critically ill elderly patients.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>audit</subject><subject>Biological and medical sciences</subject><subject>Comorbidity</subject><subject>critically ill</subject><subject>Cross Infection - epidemiology</subject><subject>Cross Infection - prevention & control</subject><subject>Eating</subject><subject>elderly</subject><subject>Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intensive care medicine</subject><subject>Length of Stay</subject><subject>Linear Models</subject><subject>Male</subject><subject>Medical Audit</subject><subject>Medical sciences</subject><subject>nosocomial infections</subject><subject>nutritional support</subject><subject>Nutritional Support - standards</subject><subject>Nutritional Support - statistics & numerical data</subject><subject>Outcome Assessment (Health Care)</subject><subject>Pressure Ulcer - epidemiology</subject><subject>Pressure Ulcer - prevention & control</subject><subject>pressure ulcers</subject><subject>Prospective Studies</subject><subject>Protein-Energy Malnutrition - classification</subject><subject>Protein-Energy Malnutrition - diagnosis</subject><subject>Protein-Energy Malnutrition - therapy</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><issn>0261-5614</issn><issn>1532-1983</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkMtq3DAUQEVpSSZpPqFFixKShVPJsmRrVUrIo5DQQNu1kKWrokRjO5IcmL-PPDO03XV1H5z74CD0gZILSqj4_IPUglZc0OZMyvOOkJZX9Ru0opzVFZUde4tWf5BDdJTSIyGEs7Y7QIeU8LYjNVuhp4c4pglM9i-A9Wx9Tnh0-HnWwefNkj5c3eMIZvw9-OzHAevB4mHOcVvpgNM8TWPM2A_YLE2jQ9hgHwKGYCGWfNLZw5DTe_TO6ZDgZB-P0a_rq5-Xt9Xd95tvl1_vKsMkyZWw0nHnWN32DTSiZ0LIpjdAXM25sUJL2suOO6Ilk43rNXN1T4URrQRuDWXH6HS3d4rj8wwpq7VPBkLQA4xzUkIyVi7VBeQ70BQJKYJTU_RrHTeKErVYVlvLalGopFRby2qZ-7g_MPdrsP9M7bQW4NMe0Kn4cFEPxqe_nOxo14qCfdlhUGy8eIgqmWLKgPXFeFZ29P_55BX1eptI</recordid><startdate>19990801</startdate><enddate>19990801</enddate><creator>Bourdel-Marchasson, I.</creator><creator>Barateau, M.</creator><creator>Sourgen, C.</creator><creator>Pinganaud, G.</creator><creator>Sallemontaudon, N.</creator><creator>Richard-Harston, S.</creator><creator>Reignier, B.</creator><creator>Rainfray, M.</creator><creator>Emeriau, J.P.</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19990801</creationdate><title>Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patients</title><author>Bourdel-Marchasson, I. ; Barateau, M. ; Sourgen, C. ; Pinganaud, G. ; Sallemontaudon, N. ; Richard-Harston, S. ; Reignier, B. ; Rainfray, M. ; Emeriau, J.P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-6d9f5ff327b4e46b36694bce0f255cd6a91b985f0a9394fba3f2b16c679e5dc13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>audit</topic><topic>Biological and medical sciences</topic><topic>Comorbidity</topic><topic>critically ill</topic><topic>Cross Infection - epidemiology</topic><topic>Cross Infection - prevention & control</topic><topic>Eating</topic><topic>elderly</topic><topic>Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intensive care medicine</topic><topic>Length of Stay</topic><topic>Linear Models</topic><topic>Male</topic><topic>Medical Audit</topic><topic>Medical sciences</topic><topic>nosocomial infections</topic><topic>nutritional support</topic><topic>Nutritional Support - standards</topic><topic>Nutritional Support - statistics & numerical data</topic><topic>Outcome Assessment (Health Care)</topic><topic>Pressure Ulcer - epidemiology</topic><topic>Pressure Ulcer - prevention & control</topic><topic>pressure ulcers</topic><topic>Prospective Studies</topic><topic>Protein-Energy Malnutrition - classification</topic><topic>Protein-Energy Malnutrition - diagnosis</topic><topic>Protein-Energy Malnutrition - therapy</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bourdel-Marchasson, I.</creatorcontrib><creatorcontrib>Barateau, M.</creatorcontrib><creatorcontrib>Sourgen, C.</creatorcontrib><creatorcontrib>Pinganaud, G.</creatorcontrib><creatorcontrib>Sallemontaudon, N.</creatorcontrib><creatorcontrib>Richard-Harston, S.</creatorcontrib><creatorcontrib>Reignier, B.</creatorcontrib><creatorcontrib>Rainfray, M.</creatorcontrib><creatorcontrib>Emeriau, J.P.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bourdel-Marchasson, I.</au><au>Barateau, M.</au><au>Sourgen, C.</au><au>Pinganaud, G.</au><au>Sallemontaudon, N.</au><au>Richard-Harston, S.</au><au>Reignier, B.</au><au>Rainfray, M.</au><au>Emeriau, J.P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patients</atitle><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle><addtitle>Clin Nutr</addtitle><date>1999-08-01</date><risdate>1999</risdate><volume>18</volume><issue>4</issue><spage>233</spage><epage>240</epage><pages>233-240</pages><issn>0261-5614</issn><eissn>1532-1983</eissn><coden>CLNUDP</coden><abstract>Undereating is a frequent concern in acute care geriatric settings and is supposed to worsen the outcomes of the underlying diseases, while the quality of nutritional support could be improved.
Two consecutive and prospective audits (A and B) with team training over a1 year period investigated the quality of malnutrition recognition and nutritional support and outcomes in immobilized, critically ill elderly subjects. Results: Audit A included 170 patients (86.3±6.1 years old) and audit B, 232 patients (86.3±6.3), respectively 20.6% and 31.4% of the hospitalized population. Misclassifications occurred in A in 54.0% compared to 34.05% in B (
P < 0.001). 32.6% in A versus 86.9% in B adequately received oral supplements (
P = 0.02). Significant risk factors for the adverse outcomes in the combined two audits were: dementia (RR: 1.8, 95%CI: 1.0 to 3.0,
P = 0.04) and dehydration (RR: 2.0, 95%C1:1.0 to 4.1,
P = 0.05) for pressure ulcer incidence; stroke (RR: 8.8, 95%CI: 4.8 to 16.0,
P < 0.001) for pressure ulcer prevalence at discharge; neoplasms (RR: 1.1, 95%CI: 1.0 to 1.2,
P = 0.02) for nosocomial infections; bladder indwelling for urinary tract infections (RR: 4.8, 95%CI: 2.9 to 7.7,
P < 0.001); swallowing problems for pulmonary infections (RR: 5.4, 95%CI: 2.8 to 10.5,
P < 0.001); venous indwelling for septicaemia (RR: 5.4, 95%CI: 1.3 to 23.3,
P = 0.02). However, after adjustment on significant risk factors, the outcome rate was similar in audit B: death rate: A (15.6%), B (14.2%); length of stay: A (17.3±10.4 days), B (17.4±10.0); pressure ulcer incidence: A (26.4%), B (20.2%), (83% were erythema); pressure ulcer prevalence at discharge: A (14.7%), B (10.3%), (40% were erythema); nosocomial infections: A (26.4%), B (19.0%).
The improvement of malnutrition recognition and nutritional support was not followed by aperceptible decrease in adverse outcome rate, this latter being mainly related to the underlying conditions of these critically ill elderly patients.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>10578023</pmid><doi>10.1016/S0261-5614(99)80075-2</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Clinical nutrition (Edinburgh, Scotland), 1999-08, Vol.18 (4), p.233-240 |
| issn | 0261-5614 1532-1983 |
| language | eng |
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| source | MEDLINE; Access via ScienceDirect (Elsevier) |
| subjects | Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy audit Biological and medical sciences Comorbidity critically ill Cross Infection - epidemiology Cross Infection - prevention & control Eating elderly Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition Female Humans Incidence Intensive care medicine Length of Stay Linear Models Male Medical Audit Medical sciences nosocomial infections nutritional support Nutritional Support - standards Nutritional Support - statistics & numerical data Outcome Assessment (Health Care) Pressure Ulcer - epidemiology Pressure Ulcer - prevention & control pressure ulcers Prospective Studies Protein-Energy Malnutrition - classification Protein-Energy Malnutrition - diagnosis Protein-Energy Malnutrition - therapy Risk Factors Treatment Outcome |
| title | Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patients |
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