BACKGROUND Undernourished patients discharged from the hospital require follow-up; however, attendance at return visits is low. Teleconsultations may allow remote follow-up of undernourished patients; however, no valid method to remotely perform physical examination, a critical component of assessing nutritional status, exists. OBJECTIVE This study aims to compare agreement between photographs taken by trained dietitians and in-person physical examinations conducted by trained dietitians to rate the overall physical examination section of the scored Patient Generated Subjective Global Assessment (PG-SGA). DESIGN Nested cross-sectional study. PARTICIPANTS/SETTING Adults aged ≥60 years, admitted to the general medicine unit at Flinders Medical Centre between March 2015 and March 2016, were eligible. All components of the PG-SGA and photographs of muscle and fat sites were collected from 192 participants either in the hospital or at their place of residence after discharge. MAIN OUTCOME MEASURES Validity of photograph-based physical examination was determined by collecting photographic and PG-SGA data from each participant at one encounter by trained dietitians. A dietitian blinded to data collection later assessed de-identified photographs on a computer. STATISTICAL ANALYSES PERFORMED Percentage agreement, weighted kappa agreement, sensitivity, and specificity between the photographs and in-person physical examinations were calculated. All data collected were included in the analysis. RESULTS Overall, the photograph-based physical examination rating achieved a percentage agreement of 75.8% against the in-person assessment, with a weighted kappa agreement of 0.526 (95% CI: 0.416, 0.637; P<0.05) and a sensitivity-specificity pair of 66.9% (95% CI: 57.8%, 75.0%) and 92.4% (95% CI: 82.5%, 97.2%). CONCLUSIONS Photograph-based physical examination by trained dietitians achieved a nearly acceptable percentage agreement, moderate weighted kappa, and fair sensitivity-specificity pair. Methodological refinement before field testing with other personnel may improve the agreement and accuracy of photograph-based physical examination.

中文翻译：

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评估照片作为对老年医院患者评分的患者生成的主观总体评估的亲自体检的替代

背景 出院的营养不足患者需要随访；然而，回访的出席率很低。远程会诊可能允许对营养不良的患者进行远程随访；然而，目前还没有有效的方法来远程进行身体检查，这是评估营养状况的一个关键组成部分。目的 本研究旨在比较训练有素的营养师拍摄的照片与训练有素的营养师亲自进行的身体检查之间的一致性，以对评分的患者生成主观整体评估 (PG-SGA) 的整体身体检查部分进行评分。设计嵌套横断面研究。参与者/设置 2015 年 3 月至 2016 年 3 月期间入住弗林德斯医疗中心普通医学科的 60 岁以上的成年人符合条件。PG-SGA 的所有组成部分以及肌肉和脂肪部位的照片均来自 192 名出院后在医院或居住地的参与者。主要观察指标 由训练有素的营养师通过收集每位参与者的照片和 PG-SGA 数据来确定基于照片的体检的有效性。一位对数据收集不知情的营养师后来在计算机上评估了去识别化的照片。执行的统计分析 计算了照片和现场体检之间的百分比一致性、加权 kappa 一致性、敏感性和特异性。收集到的所有数据都包含在分析中。结果 总体而言，基于照片的体检评分与亲自评估的百分比一致，为 75.8%，加权 kappa 一致性为 0.526（95% CI：0.416，0.637；P<0.05），敏感性-特异性对分别为 66.9%（95% CI：57.8%，75.0%）和 92.4%（95% CI：82.5%） , 97.2%)。结论 由训练有素的营养师进行的基于照片的体检达到了几乎可以接受的百分比一致性、中等加权 kappa 和公平的敏感性-特异性对。与其他人员进行现场测试之前的方法改进可以提高基于照片的体检的一致性和准确性。