Application of Subjective Global Assessment as a Screening Tool for Malnutrition in Pediatric Surgical Patients
Chalermporn Rojratsirikul MD*, Surasak Sangkhathat MD*, Sakda Patrapinyokul MD*
Affiliation : * Department of Surgery, Faculty of Medicine, Prince of Songkla University
Objectives : To determine the incidence of malnutrition in the pediatric surgical ward and to evaluate the
value of SGA as a nutrition assessment tool in this patient group.
Patients and Method : Consecutive pediatric patients aged 2 months -16 years who were admitted for an
operation in the pediatric surgical ward, Songklanagarind Hospital from February to September 2001 were
included. Nutritional assessment was performed for each case, using a translated version of the SGA
questionnaire. Anthropometric measurements and laboratory tests were performed as a routine pre-operative
evaluation. The result of the SGA ratings were tested against the other parameters and Gomez’s weight for
age (W/A) criteria for protein energy malnutrition. SGA and the other parameters were tested for association
with post-operative infectious complications. Each SGA question was analyzed by multivariate logistic
regression analysis, to determine an independent correlation between the question item and final SGA
rating.
Results : The study included 78 patients. At least one item of SGA history was positive in 28 cases (35.9%).
The SGA rating was class A in 50 cases (64.1%), class B in 17 cases and class C in 11 cases. According to the
Gomez classification, 42 cases (53.8%) were considered normal or overweight, whereas 23 cases (29.5%)
were in the first degree underweight, 9 cases were in the second degree and 4 cases were in the third degree.
Malnutrition by SGA rating correlated significantly with Gomez’s second and third degree malnutrition,
lower z-score, lower BMI and hypoalbuminemia. Malnutrition by SGA rating and hypoalbuminemia were
associated with increased risk of an infectious complication, whereas a significant relation between a
complication and anthropometric malnutrition could not be demonstrated. Moreover, SGA malnutrition was
significantly associated with a longer post-operative stay.
Among 5 items of SGA questions, history of weight change in the recent 2 weeks and increased
energy need considered by an underlying disease were found to be independently associated with a final
SGA rating of malnutrition. History of weight loss and gastrointestinal symptoms were the 2 most sensitive
questions.
Conclusions : SGA is a sensitive and specific nutrition assessment tool useful in a pre-operative pediatric
setting. Application of the protocol as a complement of standard anthropometric tool should be considered.
Keywords : Malnutrition, Subjective Global Assessment, Pediatric surgery, Nutritional assessment
