ORIGINAL ARTICLE Validation of the spinal nutrition screening tool (SNST) in patients with spinal cord injuries (SCI): result from a multicentre study S Wong 1,2 , F Derry 1 , A Jamous 1 , SP Hirani 3 , G Grimble 2 and A Forbes 2 1 National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK; 2 Centre of Gastroenterology and Clinical Nutrition, University College London, London, UK and 3 School of Community and Health Science, City University, London, UK Background/Objectives: A disease-specific nutrition screening tool (NST): the spinal nutrition screening tool (SNST) has been developed for use in patients with spinal cord injury (SCI) but its reliability and agreement with other published tools requires investigation. The aims of this study were to assess the prevalence of malnutrition risk in SCI patients and to confirm the diagnostic accuracy of the SNST. Subjects/Methods: Patients’ baseline clinical data, anthropometric measurements and NST scores were assessed. The validity of the SNST was assessed by (i) comparing with a full dietetic assessment (criterion validity); (ii) comparison with a generic NST: malnutrition universal screening tool (MUST) (concurrent validity); and (iii) completion of an additional SNST to assess inter- and intra-rater reliability. Agreement was assessed using Cohen’s k-statistics. Results: Using the SNST, the prevalence of malnutrition risk ranged from 22 to 64% on admission to four SCI centres. The SNST had substantial agreement with MUST (k: 0.723, 95% confidence interval (CI): 0.607–0.839) and dietitian assessment (k: 0.567, 95% CI: 0.434–0.699). The SNST had a moderate to substantial reliability (inter-rater reliability: k: 0.5, 95% CI: 0.2–0.8; intra-rater reliability: k: 0.64, 95% CI: 0.486–0.802). When compared with dietetic assessment, the SNST had a numerically lower specificity (76.1% vs 80.4%) and similar agreement to MUST (k: 0.57 vs 0.58) but SNST showed a numerically higher sensitivity (85.7% vs 80.4%) and a numerically higher negative predictive value (92% vs 89.2%) than MUST. Conclusions: This study shows that malnutrition is common in SCI patients. The SNST is an acceptable (valid and reliable) NST and may be a useful alternative to MUST in identifying SCI patients at risk of malnutrition. European Journal of Clinical Nutrition (2012) 66, 382–387; doi:10.1038/ejcn.2011.209; published online 14 December 2011 Keywords: malnutrition; spinal cord injuries; nutrition screening tool Introduction Malnutrition is both a cause and a consequence of illness, particularly in vulnerable patient groups such as those with spinal cord injuries (SCIs) (MASCIP, 2010). It leads to poorer clinical outcomes such as infection, extended hospital stay, reduced quality of life and increased health- care costs (NICE, 2006, NHS Institute for Innovation and Improvement, 2009, Brotherton et al., 2010). Evidence from the general literature suggests that malnutrition is common (13–78%) and figures are higher still if atten- tion is targeted on specific vulnerable groups (Kubrak and Jensen, 2007). In the absence of a gold standard, researchers have been led to develop various nutritional indices that could be used to stratify patients at an increased risk of poorer outcomes because of malnutrition. The use of a valid nutrition screening tool (NST) could assist the process of accurately identifying those patients who are at risk of developing malnutrition. Appropriate identification and Received 12 July 2011; revised 16 November 2011; accepted 17 November 2011; published online 14 December 2011 Correspondence: S Wong, Department of Nutrition and Dietetics, National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK. E-mail: Samford.Wong@ucl.ac.uk Part of the study data were presented at the Nutrition Society annual meeting in July 2011 at University of Reading, UK and International Spinal Cord Society annual meeting in June 2011. Contributors: SW—protocol development, data collection, data analysis, manuscript preparation. FD—protocol development, clinical supervision, manuscript revision. AJ—clinical supervision, manuscript revision. SPH— statistical supervision, manuscript revision. GG—Academic supervision, manu- script revision. AF—Academic supervision, manuscript revision. European Journal of Clinical Nutrition (2012) 66, 382–387 & 2012 Macmillan Publishers Limited All rights reserved 0954-3007/12 www.nature.com/ejcn