Validation of a Screening Tool to Identify the Nutritionally at-Risk Pregnancy
Validation of a Screening Tool to Identify the Nutritionally at-Risk Pregnancy
复制标题
DOI：
10.1016/s1701-2163(16)32710-4
复制
发表时间：
2008-01-01
影响因子：
1.8
通讯作者：
Desrosiers-Choquette, Janine
中科院分区：
文献类型：
--
作者：
Duquette, Marie-Paule;Payette, Helene;Desrosiers-Choquette, Janine
目的：评估一种由护士使用的筛查工具的有效性，以确定哪些经济困难的孕妇最有可能从营养师的强化干预中受益。
方法：在蒙特利尔的17个初级保健机构中，53名护士在首次接触300名符合低收入妇女产前项目资格的受试者时使用了26个变量的筛查工具。其中，259名受试者随后由蒙特利尔饮食服务处（MDD）的营养师使用希金斯方法进行访谈，该方法被确立为检测有营养风险妊娠的金标准。营养师使用希金斯方法获得的结果与护士使用筛查工具获得的评分（用于确定风险水平和个体变量）进行比较，使用皮尔逊相关系数、受试者工作特征（ROC）曲线以及敏感性、特异性和预测值等预测指标进行分析。
结果：由于MDD营养师的发现与使用筛查工具的护士之间一致性较低，排除了10个变量。由此产生的16个变量的工具显示相关系数为0.70。这个简化工具的ROC截断值为8，这意味着如果一名妇女的得分是8分或更高，她将被视为有营养风险。这个分数优化了敏感性（85%），但特异性较低（50%），不过保留了87%的阳性预测值和55%的阴性预测值。
结论：对用于识别有营养风险孕妇的筛查工具进行修订，产生了一种简化的筛查工具，其对孕期营养风险的测量是可接受的。因此，任何卫生专业人员使用该工具都将识别出大多数最有可能从营养师的强化干预中受益的有营养风险的孕妇。
Objective: To assess the efficacy of a screening tool to be used by nurses to determine which economically disadvantaged pregnant women are most likely to benefit from a dietitian's intensive intervention.Methods: The 26-variable screening tool was used by 53 nurses in 17 Montreal primary care facilities at first contact with 300 subjects who were eligible for prenatal programs for low-income women. Among these, 259 subjects were subsequently interviewed by a Montreal Diet Dispensary (MDD) dietitian using the Higgins Method, established as the gold standard for the detection of a nutritionally at-risk pregnancy. Comparisons of the results obtained by dietitians using the Higgins Method with scores obtained by nurses using the screening tool to determine risk levels and individual variables were analyzed using the Pearson correlation coefficient, receiver operating characteristic (ROC) curves, and predictive indices such as sensitivity, specificity, and predictive values.Results: Because of low agreement between the findings of MDD dietitians and nurses using the screening tool, 10 variables were excluded. The resulting 16-variable tool showed a correlation coefficient of 0.70. The ROC cut-off for this simplified tool was 8, meaning that a woman would be considered at nutritional risk if her score was 8 or more. This score optimized sensitivity (85%) with rather low specificity (50%), but retained a positive predictive value of 87% and a negative predictive value of 55%.Conclusion: Revisions of the screening tool to identify nutritionally at-risk pregnant women led to the development of a simplified screening tool with an acceptable measure of nutritional risk in pregnancy. Hence, the use of this tool by any health professional will identify the majority of the nutritionally at-risk pregnant women most likely to benefit from a dietitian's intensive intervention.