Spinal Cord Injury Centres (SCICs) report different practices in nutritional screening( Reference Wong 1 ). A modified disease specific nutrition screening tool: the Spinal Nutrition Screening Tool (SNST-2) based on eight parameters (body mass index; age; level of SCI; presence of co-morbidities; skin conditions; diet; appetite and ability to eat) has been developed for use in SCICs. Its reliability and agreement with the previously validated, published tool (SNST-1)( Reference Wong 2 ) needs to be assessed before its use is implemented in SCICs. The aim of the study was to test validity of the modified SNST-2.( Reference Gandy 3 ) Patients' baseline clinical data, anthropometric measurements and SNST-2 score were assessed in a SCIC in the Republic of Ireland during a 6 months period. The validity of SNST-2 was tested by (i) comparison with the previously validated SNST-1( Reference Wong 2 ) (concurrent validity) and (ii) an additional SNST-2 was completed by the research dietitian and ward nurses to assess inter- and intra-rater reliability. Agreement was tested using Cohen's κ-statistics( Reference Landis and Koch 4 ). 30 patients (aged 20–90 years, median: 54 years, 63·2% female; 23·3% tetraplegic SCI) were studied. Using SNST-2 on admission, 7 patients (23·3%) were at risk of undernutrition. The SNST-2 had “substantial agreement” with SNST-1 (κ: 0·902, 95% CI: 0·714–1·000). The SNST-2 had substantial reliability (inter-rater reliability (dietitian vs nurse) κ: 0·902, 95% CI: 0·714–1·0). The SNST-2 may be an acceptable (valid and reliable) tool in identifying SCI patients at risk of malnutrition. Further investigation with a larger sample size is warranted to test its predictive validity.
The authors would like to thank the patients and staff from Our Lady's Ward and Spinal Cord System of Care Programme for facilitating the study. We would like to thank Anthony Twist, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Philippa Bearne, Salisbury District Hospital for development of the modified SNST.
