What is the NRS Nutrition Screening Tool?

The Nutritional Risk Screening Tool (NRS 2002) is recommended by the European Society for Parenteral and Enteral Nutrition (ESPEN) for use in hospitals to detect malnutrition risk. This tool is crucial for identifying patients who may require nutritional support, thereby reducing complications and improving patient outcomes.

Quick Summary

The NRS 2002 is a nutritional screening tool for hospital patients, involving initial and final screening steps to assess the risk of malnutrition based on nutritional status, disease severity, and age. It is used to identify patients who would benefit from a nutritional care plan.

Key Points

• Two-Step Process: The NRS 2002 uses an initial quick screening with four 'Yes'/'No' questions, followed by a more detailed final assessment for at-risk patients.

• Scoring Components: The final score is based on three factors: impaired nutritional status (0-3), disease severity (0-3), and an age adjustment for patients 70 or older (+1).

• Intervention Threshold: A total score of 3 or higher indicates nutritional risk, prompting the initiation of a nutritional care plan.

• Predictive Value: A higher NRS 2002 score correlates with a greater risk of adverse clinical outcomes, such as higher mortality and longer hospital stays.

• Cost-Effectiveness: By enabling early nutritional intervention, the NRS 2002 can help reduce overall healthcare costs associated with complications and extended hospitalizations.

• Best Practices: For optimal use, screening should occur within 48 hours of hospital admission, with weekly rescreening for low-risk patients and referral to a dietitian for those at higher risk.

• Evidence-Based Foundation: The tool is built upon an interpretation of controlled clinical trials, providing a strong scientific basis for its methodology.

What is the NRS Nutrition Screening Tool?

The NRS Nutrition Screening Tool, also known as NRS 2002, is an evidence-based method designed to identify hospitalized adult patients at risk of malnutrition. Developed by experts including Kondrup, the tool helps healthcare professionals determine which patients may benefit from nutritional support, potentially improving clinical outcomes and reducing hospital stays.

The Two-Step NRS 2002 Process

The NRS 2002 utilizes a two-step approach for screening:

Initial Screening

This first step involves answering four 'Yes' or 'No' questions:

1. Is the patient's BMI below 20.5 kg/m²?
2. Has the patient experienced weight loss in the past three months?
3. Has the patient's dietary intake decreased in the last week?
4. Is the patient severely ill?

A 'Yes' to any question leads to the final screening. If all answers are 'No', the patient is low risk and rescreened weekly.

Final Screening and Scoring

The final screening assesses risk using three components, each contributing to a total score:

• Nutritional Status Score (0–3): Evaluates impaired nutritional status based on factors like weight loss and reduced intake.
• Severity of Disease Score (0–3): Assesses the metabolic stress from the patient's illness.
• Age Adjustment (+1): Adds a point for patients aged 70 or older.

A total score of 3 or more indicates nutritional risk and necessitates a nutritional care plan.

Benefits and Limitations of the NRS 2002

Benefits

• Prognostic Value: A higher score predicts worse outcomes, such as increased mortality and longer hospital stays.
• Evidence-Based: The tool is rooted in an analysis of randomized controlled trials.
• Simple and Flexible: It's easy to use across various hospital settings and patient groups.
• Cost-Effective: Early identification and intervention can reduce costs associated with complications and extended hospitalizations.

Limitations

• Screening vs. Diagnosis: It's a screening tool, not a diagnostic one, though it correlates well with diagnostic criteria like GLIM.
• Context Sensitivity: Predictive accuracy can vary by patient population.
• Intervention Prediction: Some evidence suggests a modified version might better predict response to nutritional therapy.

Comparison of NRS 2002 with Other Nutritional Screening Tools

The NRS 2002 is one of several available screening tools:

Feature	NRS 2002	Malnutrition Universal Screening Tool (MUST)	Mini Nutritional Assessment Short Form (MNA-SF)
Target Population	Hospitalized adults, all ages	Adults (hospital, community, care homes)	Older adults (age 65+)
Key Parameters	Nutritional status, disease severity, age	BMI, unintentional weight loss, acute disease effect	Food intake decline, weight loss, mobility, stress, BMI, acute disease
Scoring	Numerical score (0–7)	Low, medium, or high risk	Well-nourished, at risk, or malnourished
Predictive Power	Predicts outcomes (mortality, LOS)	Predicts LOS, discharge, mortality	Predicts hospital stay, mortality
Ease of Use	Relatively simple	Simple	Quick, 6-question screen
Evidence Base	Based on trials	Validated in various settings	Most validated for elderly

Best Practices for Utilizing NRS 2002 in a Clinical Setting

Effective use of the NRS 2002 involves:

• Timely Screening: Screen all patients within 48 hours of admission.
• Regular Rescreening: Rescreen low-risk patients weekly.
• Multidisciplinary Approach: Involve dietitians for positive screens.
• Comprehensive Assessment: A positive screen requires a full nutritional assessment.
• Actionable Care Plan: Develop specific interventions for at-risk patients.

Conclusion

The NRS 2002 is an important tool for identifying hospitalized adults at nutritional risk. Its two-step process efficiently stratifies risk based on nutritional status, disease severity, and age. The tool's ability to predict adverse outcomes highlights its value in clinical practice, facilitating timely nutritional support. Despite some limitations, the NRS 2002's strengths in early detection and validated predictive capacity make it a key component of modern patient care, promoting better health outcomes.

NRS 2002: A Vital Part of Nutritional Care

Implementing the NRS 2002 helps standardize nutritional screening, ensuring this crucial aspect of patient management is not overlooked. This leads to improved patient care and recovery by addressing malnutrition early.

Frequently Asked Questions

Who developed the NRS 2002?

The Nutritional Risk Screening Tool (NRS 2002) was developed by a group of European experts, notably Kondrup et al., based on evidence from randomized controlled clinical trials.

What is considered a 'positive' NRS 2002 screen?

A total NRS 2002 score of 3 or higher is considered positive and indicates that the patient is at nutritional risk. This triggers the need for a nutritional care plan.

Is the NRS 2002 only for the elderly?

No, the NRS 2002 is for hospitalized adults of all ages. However, it does include an age adjustment, adding a point to the score for patients aged 70 or older, recognizing their increased risk.

How often should a patient be screened with NRS 2002?

A patient should be screened within 48 hours of hospital admission. If they are deemed low-risk (score < 3), they should be rescreened on a weekly basis.

Does a positive NRS 2002 score diagnose malnutrition?

No, the NRS 2002 is a screening tool used to identify risk. A positive score indicates the need for a more comprehensive nutritional assessment by a qualified professional, such as a registered dietitian, to formally diagnose malnutrition.

What happens if a patient scores positive on the NRS 2002?

If a patient scores positive (≥3), a nutritional care plan is initiated. This plan can involve dietary modifications, oral nutritional supplements, or other interventions based on the severity of the risk and the patient's condition.

Is NRS 2002 suitable for all hospital patients?

The NRS 2002 is designed for general adult hospital populations. While highly effective, some variations or specific tools might be more appropriate for highly specialized patient groups, such as those in intensive care.