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Are photographs a valid replacement for the in-person physical examination of the scored Patient-Generated Subjective Global Assessment?
- Miller, Michelle, Thomas, Jolene, Suen, Jenni, Ong, De Sheng, Sharma, Yogesh
- Journal of the Academy of Nutrition and Dietetics 2017
- clinical examination, data collection, dietitians, hospitals, human resources, malnutrition, medicine, muscles, nutritional status, patients, photographs
- Undernourished patients discharged from the hospital require follow-up, however attendance at return visits is low. Tele-consultations may allow remote follow-up of undernourished patients; however, no valid method to remotely perform physical examination, a critical component of assessing nutritional status, exists.This study aims to compare agreement between photographs taken by trained dietitians and in-person physical examination conducted by trained dietitians to rate the overall physical examination section of the scored Patient-Generated Subjective Global Assessment (PG-SGA).Nested cross-sectional study.Adults ≥60 years, admitted to the General Medicine Unit at Flinders Medical Centre between March 2015 and March 2016, were eligible. All components of the PG-SGA and photographs of muscle and fat sites were collected from 192 participants either in hospital or their place of residence post-discharge.Validity of photograph-based physical examination was determined by collecting photograph and PG-SGA data from each participant at one encounter by trained dietitians. A dietitian blinded to data collection later assessed de-identified photographs on a computer.Percentage agreement, weighted kappa agreement, sensitivity and specificity between the photograph and in-person physical examinations were calculated. All data collected were included in analysis.Overall the photograph-based physical examination rating achieved a percentage agreement of 75.8% against the in-person assessment, with a weighted kappa agreement of 0.526 (95% CI: 0.416, 0.637; p<0.05) and a sensitivity-specificity pair of 66.9% (95% CI: 57.8%, 75.0%) and 92.4% (95% CI: 82.5%, 97.2%).Photograph-based physical examination by trained dietitians achieved a near acceptable percentage agreement, moderate weighted kappa and fair sensitivity-specificity pair. Methodological refinement prior to field-testing with other personnel may improve the agreement and accuracy of photograph-based physical examination