I. Shnaydman1, J. McLatchy1, R. Barrera1 1North Shore University And Long Island Jewish Medical Center,Manhasset, NY, USA
Introduction:
Critically ill patients suffer from nutritional deficiency, resulting in poor wound healing, prolonged ventilator dependence and poor outcomes. There is currently no objective method to accurately assess nutritional status and determine effectiveness of nutritional support. Albumin, Prealbumin and Transferrin have been used as nutritional markers, but are unreliable in the critically ill patient due to being acute phase reactants. Radiologic Interpretation at Base of Spine, RIBS, was created to objectively assess nutrition and correlate to postoperative outcomes. The purpose of this study is to evaluate the reproducibility, reliability and clinical potential of the RIBS application.
Methods:
The RIBS application, developed by one of the authors, allows users to determine the ratio of visceral fat to muscle tissue. The easy to use program guides users through a few steps involving uploading a scan of the sacral area obtained from a routine CTAP and selecting the boundaries of fat and muscle adjacent to the spine. The application calculates this ratio of fat to muscle to determine a RIBS score. The application is cross-platform compatible and may be used on desktop computers and handheld devices.
Twenty surgical residents were given a brief introduction, and then ran the application on the same series of images. Half of the subjects used a portable device and half used a desktop computer. Results were compared to determine average time to completion, intra and inter-user reliability and reproducibility.
Clinical use of the RIBS application was assessed using a case study that followed the hospital course of a critically ill patient over the course of a year. RIBS scores were compared to albumin, prealbumin and BMI.
Results:
Preliminary results demonstrate the reliability and reproducibility of the RIBS application. Test subjects found the program practical with an average completion time of 8 and 12 seconds on desktop and mobile devices respectively.
The case study showed that RIBS scores can provide clinical insight into the nutritional status of a patient. The RIBS scores correlated positively with BMI, Albumin and Prealbumin.
Conclusion:
In critically ill patients, appropriate nutritional support is often based on caloric need with adjustments made for specific illnesses. During an inflammatory process such as sepsis, it is important to use an objective marker for nutrition to both assess a patient’s prognosis as well as to trend their response to nutritional support. The data suggests that RIBS could be used to accurately and easily assess nutritional status. Further research is underway to determine the efficacy of RIBS as a nutritional marker and correlate it to outcome measures.
