A Protein Energy Malnutrition Scale (PEMS)

Abstract

Most assessments of protein energy malnutrition have relied on clinical impressions, laboratory tests or anthropometric measurements. There was a split in the field between those who favor clinical vs. laboratory approaches, and each alone misclassifies about 20% of the patients. A 23-item scale is described that provides 4 subscores derived from anthropometric measurements, clinical history, physical examination and laboratory tests, as well as a total score. Items rated on logarithmic scales relate to degree of deviation from standards. Reliability was tested by having 2 physicians rate the same 25 patients and items with better than r = 0.66 retained. Validating information came from the finding that the scale discriminated before surgery (P < 0.001) between patients who did and did not develop postoperative complications. Use of the scale appears to be a good approach for assessing degree of malnutrition as well as for monitoring changes that occur over time.