Introduction and Objectives Targeting nutritional status is a key issue in COPD. Studies have shown increased mortality in patients with low BMI1 which improves following weight gain.2 This study examines whether nutritional status is adequately assessed and acted upon in COPD patients admitted to a DGH.
Method Patients admitted to the RUH, Bath with a COPD exacerbation over a 4-month period were prospectively included. Case notes were reviewed to determine whether BMI had been documented. If a BMI wasn't documented, patients' height and weight was measured allowing calculation of BMI. Notes were also assessed for dietician referrals, nutritional supplement prescription and whether patients had their weight monitored. Length of stay (LOS) and in-hospital survival data were collected.
Results BMI was recorded in 25/51 of the patients included (mean age 74 yrs, 47% male.) In 88% of cases BMI had been estimated not calculated. Of these, 11/25 patients had had their BMI additionally calculated by the study investigators—4/11 patients had been estimated to have a normal BMI when in fact they were underweight. 13/51 patients had a BMI <18. Patients with BMI <18 had a lower percentage predicted FEV1 (32% vs 52% p=0.02) and a lower Urea level (5.6 mmol/l vs 7.9 mmol/l p=0.04). 1/13 were referred to a dietician, 8/13 were prescribed nutritional supplements and nutrition wasn't addressed in 4/14 patients. Only 4/14 patients had their weight monitored. Patients with a BMI<18 exhibited similar in-hospital mortality (15.4% vs 18.4%) but had a higher LOS (26.8 days vs 15.5 days p=0.03).
Conclusion BMI measurements were poorly recorded in patients admitted to hospital. Where BMI was recorded this was estimated, rather than calculated, leading to underreporting. Only 71% of patients with low BMIs received dietetic input or nutritional supplementation during their stay. Patients with a low BMI had a significantly longer LOS.
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