8. Is performing the physical exam in the Pt-Global app/web tool© mandatory?

8. Is performing the physical exam in the Pt-Global app/web tool© mandatory?

Performance of the physical examination, which is part of the Professional screen, is not mandatory but is important. The scoring of the PG-SGA© and the algorithm that supports the Pt-Global app/web tool© is based on the preponderance (generally 80-90%) of the total PG-SGA score being based on the patient component of the Pt-Global app/web tool© (e.g. the screens on Patient, Intake, Symptoms, and Activities). The patient-generated aspects are also referred to as the PG-SGA Short Form© (SF) or the abridged PG-SGA.

It is important to note that the total score of the physical examination is 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. The other aspects of the professional components of the PG-SGA© or Pt-Global app/web tool© are the presence of fever, fever duration and use of corticosteroids. Each of these variables can have significant acute or chronic effect on muscle mass and patient function.

These variables must be taken into consideration in the assessment of your patient, even if you only utilize the PG-SGA Short Form©. For example, if the patient has a score of 7 points but is on corticosteroids or has a fever, this should make the professional address the intervention based on a higher score than that captured with the data based on Boxes 1-4 of the PG-SGA© (also known as PG-SGA Short Form©).

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.

In the Pt-Global app/web tool©, points scored will be shown irrespective of the order in which the screens are completed and irrespective of completing the Professional screen. A completed screen will be marked by the green “check icon”.