Performance of the physical examination is not mandatory but is important. The physicial exam is essential to determine the PG-SGA Category, because the PG-SGA Category is based on Boxes 1-4 of the paper version of the PG-SGA (also known as the PG-SGA Short Form©, which is equivalent to the patient component of the Pt-Global app/web tool© (Patient, Weight, Food Intake, Symptoms, Activity).
To score the numerical PG-SGA score it is important to note that the majority (generally 80-90%) of the total PG-SGA numerical score is being based on the patient-generated aspects (PG-SGA Short Form©).
Furthermore, it is important to note that muscle mass and tone, fat deficit and fluid status need to be evaluated just globally. The locations of the body described in Worksheet 4 are just to help in the global physical exam. Furthermore, the total score of the physical examination is just 3 points – so that even if one was not certain that the deficit was moderate vs severe or mild vs moderate, the difference would only be 1 point. Many find the appreciation of this as lessening some of the intimidation of doing a physical exam.
Also, appreciation of components of the physical examination can give additional insight. For example, the distribution of the loss of muscle mass can be important. If the patient is spending most of her time in bed or chair, the muscle loss you see below the waist will be a combination of disuse atrophy plus malnutrition, whereas that above the waist tends to be more prominently related to malnutrition. Also, while not specifically part of the PG-SGA©, when one is examining the patient, there may be markers of specific nutritional deficiencies that can also be appreciated, e.g., scaly dermatitis of zinc deficiency (and poor wound healing) in the patient with chronic high volume GI losses or a similar scaly dermatitis of essential fatty acid deficiency in a patient who a clinician chronically failed to order lipids with the patient’s parenteral nutrition.