Nine studies (n at least 2,786) were included: one randomised controlled trial (n=261), one non-randomised controlled trial (n=298), two before-and-after (B/A) studies with a control group (n=575) and five B/A studies without a control group (n at least 1,652). Four studies were conducted in the USA, two in the UK and one in the Netherlands.
Overall, the quality of the studies was poor. Study limitations included a lack of accounting for seasonal variation in one before-and-after study.
Patients with specific conditions. One controlled B/A study (400 stroke patients) reported that the introduction of nutritional guidelines for screening and support was associated with a significant reduction in chest infections and in urinary infections and pressure sores in patients with catheters. It was also associated with a non significant increase in referrals to dieticians and a significant increase in referrals to physiotherapists or occupational therapists, use of tube feeding, LOS, discharge destination and mortality.
One non-randomised controlled study(n=298) reported that use of a mini-nutritional assessment with follow-up was associated with a significant reduction in nocosomial infections and increased weight compared with usual care. However, it found no significant difference between interventions in the LOS and pressure sores.
One B/A study (n=589) reported that the introduction of a short nutritional assessment questionnaire plus dietetic advice plus snack was associated with a significant reduction in LOS.
One B/A study (n=68) reported that the introduction of a local nutrition screening form was associated with a significant increase in the detection of malnutrition and increased consultation, but no significant change in prescribed supplements.
One controlled B/A study (n=175) reported that a nurse's nutrition screening tool was associated with a significant increase in nutrition-related documentation, but no increase in referral to dieticians or significant change in LOS compared with a control ward. One B/A study (n=360) reported that the introduction of a local screening test and management was associated with increased nutrition awareness in nurses, increased documentation, more effective use of dietetic services, and increased artificial feeding, supplements and high protein meals.
One B/A study (n=635 for LOS) reported that a local screening tool plus management was associated with increased detection of malnutrition and reduced LOS, major complications and 30-day readmissions.
One randomised controlled trial (n=261) reported that screening for multiple health problems in office practices had no effect on the rates of detecting malnutrition compared with no screening.
One B/A study (number of participants not stated) reported that the introduction of nutritional screening was associated with increased patient satisfaction and fewer claims and medical emergencies.