Patients' nutritional status is not recorded

BMJ 1995;311:572 (26 August)

Letters

Patients' nutritional status is not recorded

EDITOR,--C J Todd and colleagues found considerable differencesamong hospitals in mortality, length of stay in hospital, andthe development of pressure sores in patients with hip fracture.¹Although the patients from the eight hospitals are said to havebeen well matched, no information is provided on the patients'nutritional status on arrival or on their subsequent nutritionalcare.

Simple anthropometric variables, such as weight in relationto height, the circumference of the midupper arm, and tricepsskin fold thickness, have been used to assess nutritional statusin patients with hip fracture and have proved to be predictorsof mortality and length of stay in hospital.² ³ Malnourishedpatients receiving supplemental oral or enteral nutrition haveshown fewer complications, a shorter stay in hospital and lowermortality.² ³ ⁴ ⁵ For example, patients receiving an oral supplementof 250 ml daily in one study had a median hospital stay of 40days, compared with 24 days in a group not given the supplement.⁴

Clearly, differences in nutritional management can be importantnot only for outcome but also for hospital costs.

Registrar Department of Clinical Biochemistry, Aberdeen RoyalInfirmary, Aberdeen AB9 2ZB

Alison Avenell

Todd CJ, Freeman CJ, Ferrante-Camilleri C, Palmer CR, Hyder A, Laxton CE, et al. Differences in mortality after fracture of hip: the East Anglian audit. BMJ 1995;310:904-8. (8 April.) [Abstract/Free Full Text]
Brown KM, Seabrook NA. Nutritional influences on recovery and length of hospital stay in elderly women following femoral fracture. Proc Nutr Soc 1992;51:132A.
Bastow MD, Rawlings J, Allison SP. Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. BMJ 1983;287:1589-92.
Delmi M, Rapin C-H, Bengo J-M, Delmas PD, Vasey H, Bonjour J-P. Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 1990;335:1013-6. [Medline]
Tkatch L, Rapin C, Rizzoli R, Slosman D, Nydegger V, Vasey H, et al. Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur. J Am Coll Nutr 1992;11:519-25. [Abstract]

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Differences in mortality after fracture of hip: the East Anglian audit: C J Todd, C J Freeman, C Camilleri-Ferrante, C R Palmer, A Hyder, C E Laxton, M J Parker, B V Payne, and N Rushton
BMJ 1995 310: 904-908. [Abstract] [Full Text]

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