Prospective Study Investigating the Prevalence and Evolution of Malnourishment in the Acute Orthopaedic Trauma Patient

Orthopaedic trauma surgeons believe that nutritional status is important. The primary aim of this studywas to prospectively investigate the prevalence and progression of malnourishment in orthopaedic trauma patients anddetermine when and what labs should be ordered. The secondary aim was to determine if malnourished patients hadincreased complications. Prospective cohort study of orthopaedic trauma patients at a Level I trauma center. Assessment of nutritionalstatus over the hospital course was performed using the Rainey MacDonald nutritional index (RMNI) and nutritionallaboratory markers on admission, day 3, day 7, and 6 weeks post-op. 98 patients were enrolled and included. On admission, 60%, 41%, and 38% of patients were malnourishedbased on albumin, prealbumin, and RMNI values, respectively, with 31% in severe acute-phase response (APR)as determined by CRP. By day 3, a significant increase in the percent of malnourished patients was noted basedon the laboratory markers, 85%, 90%, and 80%, respectively, with 70% in severe APR. On day 7, values stabilizedat 74%, 89%, 69%, with 56% in severe APR. At six weeks, malnourishment persisted in 13%, 19%, and 12%of patients, with 4% in severe APR. Older patients demonstrated a greater depression of nutritional markersthroughout the hospital stay. The prevalence of malnourishment, based on serum nutritional markers, in the presence of acuteorthopaedic injury is substantial, and it continues to rise during the acute hospital stay. Recommend obtaining prealbuminor albumin levels on hospital day 3 to assess nutritional status.Level of evidence: II