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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