Assessment of nutritional depletion and immune competence: a comparison of clinical examination and objective measurements.

: The ability of two surgeons to assess accurately nutritional depletion and immune state in surgical patients by clinical examination has been studied. The clinical status of all the surgical patients (198) in a large teaching hospital was assessed by two surgeons without knowledge of the results of objective testing. One of the surgeons had had a formal training in nutritional assessment techniques, the other had not. Each was asked to make two clinical assessments, one of nutritional depletion the other of immune competence. On the same day each patient also had an objective assessment of nutritional depletion (relative weight index) and immune competence (delayed hypersensitivity skin testing to four antigens). While the two surgeons identified more than 80% of the patients objectively assessed as being not depleted, they could pick only 40% of the patients who were depleted. Similarly, they identified 60% of the patients who reacted normally to the skin tests but they picked only 31% of the patients with impaired reactivity. The surgeon with nutritional training performed better than the untrained surgeon. This study suggests that malnourished patients cannot be adequately identified by clinical examination