Su Lin Lim1,5, Chung Yan Tong1, Emily Ang2, Beatrice Yet Li Foo3, Ivy Lian Ye Ng3,

Maree Ferguson4,5, Lynne Daniels5 1Dietetics Department, National University Hospital, Singapore, 2National Cancer Institute of Singapore, National University Hospital,

Singapore, 3Department of Nursing, National University Hospital, Singapore, 4Nutrition & Dietetics, Princess Alexandra Hospital, Australia, 5Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia

Background

Malnutrition is prevalent in hospitalized patients. Nutrition

screening is recommended for all hospitalized patients. A previous

validation study on the 3-MinNS tool demonstrated that the tool is

both sensitive and specific in identifying patients at risk of

malnutrition (Lim et al, 2009). The assessors in the original study

were dietitians but as with most nutrition screening tools, the 3-

MinNS tool is expected to be used mostly by nurses.

Objective

Methods

Validity and reliability of 3-Minute Nutrition Screening (3-MinNS)

performed by nurses on Oncology and Surgical patients

Results

The aim of this study was to determine the validity and reliability of

the 3-Minute Nutrition Screening (3-MinNS) when performed by

nurses.

Three ward-based nurses screened 121 subjects aged over 21

years using the 3-MinNS tool (Figure 1) in one oncology and two

surgical wards within 24 hours of admission. A dietitian, who was

blinded to the results of the nutrition screening, assessed the

subjects’ nutritional status using Subjective Global Assessment

(SGA) within 48 hours of admission. To assess the reliability of 3-

MinNS, 37 subjects screened by the first nurse were re-screened

by a second nurse, blinded to the results of the first nurse.

Receiver operator characteristic (ROC) curve analysis was

performed to determine the sensitivity and specificity of 3-MinNS

done by the nurses when compared to SGA done by the dietitian.

Spearman rho was used to determine the correlation between 3-

MinNS and SGA. Kappa score was calculated to determine the

inter-rater reliability of 3-MinNS among the nurses. TABLE 1: Sensitivity and specificity of 3-MinNS at different cut-off values to

determine subjects with malnutrition using Subjective Global Assessment as the

reference tool.

This current study confirms the validity of 3-MinNS and provides

new information on the reliability of the tool performed by its

intended users (nurses) on a new cohort of hospitalized patients.

3-MinNS has good inter-rater reliability, sensitivity and specificity. It

is a valid and reliable tool that can be used by nurses to identify

patients at nutrition risk on admission.

Conclusions

ROC curve analysis showed a good Area Under Curve (AUC),

which implied the most desirable sensitivity and specificity of the tool

(Figure 2). The optimal cut-off score for 3-MinNS to identify all

subjects at risk of malnutrition was 3 with sensitivity of 89% and

specificity of 88% (Table 1). The cut-off point of 3 also identified all

severely malnourished subjects (100% sensitivity, AUC = 0.922, p <

0.001). Spearman correlation between 3-MinNS and SGA was

excellent (p=0.783, p < 0.001). The agreement between the two

nurses performing the 3-MinNS tool was 78.3% with Kappa value of

0.58 (p < 0.001).

FIGURE 1. 3-Minute Nutrition Screening Tool

Lim SL et al. Asia Pac J Clin Nutr. 2009;18(3):395-403.

3-MinNS

Cutoff Score

3-MinNS to determine risk

of malnutrition

Sensitivity (%) Specificity (%)

1 98 45

2 95 65

3 89 88

4 77 97

5 57 100

6 38 100

7 16 100

8 7 100

9 0 100

p value < 0.001

Area under curve (AUC) 0.945

ROC Curve

Diagonal segments are produced by ties.

1 - Specificity

1.00.75.50.250.00

Se

nsi

tivity

1.00

.75

.50

.25

0.00

AUC = 0.95, p<0.001

FIGURE 2. Receiver operator characteristic (ROC) curve of 3-MinNS in identifying

patients at risk of malnutrition

Presented at the 14th Congress of Parenteral and Enteral Nutrition Society of Asia, Taiwan

held on 14-16 October 2011