Identifying malnutrition risk in acute medical patients: Validity and utility of Malnutrition Universal Screening Tool and Modified Malnutrition Screening Tool

Aim: Nutrition screening is increasingly conducted in hospitals during the patient admission process. We aimed to explore the ease of use of two tools in the conduct of screening by nutrition technicians (NTs), and to compare validity. The tools are Malnutrition Universal Screening Tool (MUST) and Modified Malnutrition Screening Tool (Mod-MST). Methods: A sample of 262 consecutive adult hospital patients in medical wards was screened during December 2008 to January 2009. Trained NTs used both tools to screen each patient. Dietitians who were blinded to screening results then assessed each patient using Subjective Global Assessment as a reference tool. Time taken for screening was recorded and ease of tool use was explored in interviews with technicians. Results: The specificity of MUST and Mod-MST was 85% and 83%, respectively, with sensitivity of 80% and 77%. Both tools were easy to use and could be applied to all patients, including those unable to answer interview questions. However, the MUST took two to three times longer to complete (5-7 min) using objective data. The Mod-MST collected subjective data that required interpretation by technicians. Conclusion: Specificity and sensitivity of the two tools were less than optimum at < 85%, as some patients would be misclassified. Both tools were valid and feasible to use with all medical patients, including those with whom communication cannot be established. The Mod-MST is recommended, as choice of malnutrition screening tool needs to balance efficacy with time taken to be useful for mass screening programs.