POOR NUTRITIONAL INTAKE IN ACUTE FRACTURED NECK OF FEMUR ADMISSIONS-IS THIS WELL DESCRIBED CLINICAL PROBLEM STILL UNDER MANAGED?

Background

Fractured neck of femurs cause substantial morbidity and mortality in elderly patients and represent a huge financial burden to the NHS. Hip fracture patients are generally malnourished on admission, often having poor nutritional inpatient intake, hindering recovery and increasing chances of “unfavourable outcome.” Nutritional care is included in intercollegiate guidelines for management of fractured neck of femur patients, but is nutrition a management priority in clinical practice?

Study Aim

To evaluate protein and energy intake of acute fractured neck of femur patients depending on admission MMSE, and compare these to department of health targets.

Method

40 acute fractured neck of femur admissions were recruited between December 08-March 09 and put into three groups depending on admission MMSE. Initial nutrition screening information (mid-arm circumference, grip strength, MUST score) was recorded and through food charts daily kcal and protein intake were calculated for a three day period.

Results

100% of patients recruited were high risk of malnutrition on admission. Overall average daily calorie intake over 3 days was 385.9 kCal, average protein intake was 14.1g. Intake for each group was well below recommended target intake of 1810kCal and 46.5g, p<0.05.

Discussion

On admission all 40 patients included were classified high risk for malnutrition, therefore in need of dietetic and nutritional intervention. Two patients received dietician input and oral supplementation.

Recorded nutritional intake was very low, well below target nutrient intakes for this population even before extra requirement due to the stress response is accounted for. Whilst there is a paucity of hard evidence linking poor nutrition to clinical outcome, this is likely to be detrimental to rehabilitation from surgery.

Conclusion

Despite attempted adherence to NICE nutrition guidance, involving screening tools, care plans and protected mealtimes; acutely unwell, malnourished patients are not receiving their basic nutritional requirements.