Variation in the application of methods used for predicting energy requirements in acutely ill adult patients: a survey of practice

Abstract

Objective: To determine current methods used by dietitians for estimating the energy requirement of a chronically and acutely ill adult patient and the variation in the application of methods.

Design: A cross-sectional survey including a case study.

Setting: Acute care adult hospitals in Australia.

Subjects: A total of 307 dietitians (66.2% response rate).

Intervention: Surveys were posted to hospitals. A reminder letter was sent to all hospitals 2 weeks after the initial posting and a follow-up survey was sent 6 weeks after the initial posting to non-respondents.

Results: Respondents calculated a mean energy requirement for the case study of 9780+/-1410 kJ/day. One-third of respondents calculated energy requirement within +/-500 kJ of the mean. Respondents primarily used the Schofield equations (67.4%) followed by the Harris-Benedict equations (25.9%) to estimate energy requirement. Estimates using the Schofield equations calculated the highest mean energy requirement. The median injury factor used in the calculations was 1.3 (1.0-1.5). The values and reasons for the selection of injury factors varied widely. Calculated energy requirement did not differ with the aims of nutritional care-maintaining current weight (9700+/-1370 kJ/day) or increasing weight (9790+/-1380 kJ/day).

Conclusion: There was considerable variation in the methods and factors used for estimating energy requirement, resulting in a wide range of calculated requirements. The application of prediction methods to individuals in acute care does not appear to be universally understood among dietitians. Dietitians require an understanding of the correct application, appropriate use, and limitations of these prediction methods.