The Protein Energy Malnutrition Scale (PEMS) is an assessment of malnutrition in the adult patient based on assessment of 23 items divided into 4 subscores.
Subscores:
(1) anthropometric (4 items)
(2) clinical history (4 items)
(3) physical examination (6 items)
(4) laboratory test findings (9 items)
Anthropometric Subscore
|
Parameter |
Finding |
Points |
|---|---|---|
|
percent of ideal body weight |
>= 90% |
1 |
|
|
85 – 89% |
2 |
|
|
80 – 84% |
4 |
|
|
< 80% |
8 |
|
percent weight loss from usual weight |
<= 5% |
1 |
|
|
6 - 12% |
2 |
|
|
13 – 19% |
4 |
|
|
>= 20% |
8 |
|
triceps skinfold thickness |
men: >= 9.0 mm women: >= 16 mm |
1 |
|
|
men: 7.0 – 8.9 mm women: 11.0 – 15.9 mm |
2 |
|
|
men: 5.0 – 6.9 mm women: 6.0 – 10.9 mm |
4 |
|
|
men: < 5.0 mm women: < 6.0 mm |
8 |
|
mid-arm muscle circumference |
men: >= 243 mm women: >= 192 mm |
1 |
|
|
men: 216 – 242.9 mm women: 170.0 – 191.9 mm |
2 |
|
|
men: 189.0 – 215.9 mm women: 148.0 – 169.9 mm |
4 |
|
|
men: < 189 mm women: < 148 mm |
8 |
where:
• Weight loss from usual weight does not include loss due to dieting or diarrhea.
• If not all of the data is available, then the subscore = SUM(points for items answered) / (number of items answered)
anthropometric subscore =
= SUM(points for anthropometric findings) / 4
Clinical History Subscore
|
Parameter |
Finding |
Points |
|---|---|---|
|
inadequate nutrition intake |
none |
1 |
|
|
mild |
2 |
|
|
moderate |
4 |
|
|
severe |
8 |
|
excessive nutrient losses |
none |
1 |
|
|
mild |
2 |
|
|
moderate |
4 |
|
|
severe |
8 |
|
increased metabolic needs |
none |
1 |
|
|
mild |
2 |
|
|
moderate |
4 |
|
|
severe |
8 |
|
antinutrient or catabolic medications |
none |
1 |
|
|
mild |
2 |
|
|
moderate |
4 |
|
|
severe |
8 |
where:
• Inadequate nutrient intake: alcoholism, upper GI cancer, NPO, deficient diet, poor dentition, etc.
• Excessive nutrient losses: vomiting, diarrhea, malabsorption, fistula, draining wound, proteinuria, etc.
• Increased metabolic needs: burns, fever, trauma, infection, recent surgery, pregnancy, hyperthyroidism, etc.
• Antinutrient or catabolic medications: steroids, immunosuppression, chemotherapy, etc.
• If not all of the data is available, then the subscore = SUM(points for items answered) / (number of items answered)
clinical history subscore =
= SUM(points for laboratory test findings) / 4
Physical Examination Subscore
|
Parameter |
Finding |
Points |
|---|---|---|
|
cachexia |
none |
1 |
|
|
mild |
2 |
|
|
moderate |
4 |
|
|
severe |
8 |
|
hair (easily pluckable) and nails (brittle or ridged) |
none |
1 |
|
|
mild |
2 |
|
|
moderate |
4 |
|
|
severe |
8 |
|
hepatomegaly and ascites |
none |
1 |
|
|
mild |
2 |
|
|
moderate |
4 |
|
|
severe |
8 |
|
muscle atrophy |
none |
1 |
|
|
mild |
2 |
|
|
moderate |
4 |
|
|
severe |
8 |
|
generalized edema |
none |
1 |
|
|
mild |
2 |
|
|
moderate |
4 |
|
|
severe |
8 |
|
skin changes (dry, scaling, lesions) |
none |
1 |
|
|
mild |
2 |
|
|
moderate |
4 |
|
|
severe |
8 |
where:
• muscle atrophy is based on a generalized estimations and examination of the temporal, hand and calf muscles
• If not all of the data is available, then the subscore = SUM(points for items answered) / (number of items answered)
physical examination subscore =
= SUM(points for physical examination findings) / 6
Laboratory Test Findings Subscore
|
Parameter |
Finding |
Points |
|---|---|---|
|
serum albumin |
>= 3.5 g/dL |
1 |
|
|
2.8 – 3.4 g/dL |
2 |
|
|
2.1 – 2.7 g/dL |
4 |
|
|
< 2.1 g/dL |
8 |
|
hemoglobin |
>= 14 g/dL |
1 |
|
|
12.0 – 13.9 g/dL |
2 |
|
|
10.0 – 11.9 g/dL |
4 |
|
|
< 10 g/dL |
8 |
|
delayed hypersensitivity skin tests |
2, 3 or 4 reaction >= 5 mm |
1 |
|
|
1 reaction >= 5 mm |
2 |
|
|
any < 5 mm |
4 |
|
|
0 mm |
8 |
|
absolute lymphocyte count |
>= 1,500 per µL |
1 |
|
|
1,200 – 1,499 per µL |
2 |
|
|
1,000 – 1,199 per µL |
4 |
|
|
< 1,000 per µL |
8 |
|
creatinine excretion index |
>= 80% of standard |
1 |
|
|
60 – 79% of standard |
2 |
|
|
40 – 59% of standard |
4 |
|
|
< 40% of standard |
8 |
|
serum transferrin |
>= 200 mg/dL |
1 |
|
|
150 – 199 mg/dL |
2 |
|
|
100 – 149 mg/dL |
4 |
|
|
< 100 mg/dL |
8 |
|
retinol binding protein |
>= 3.0 mg/dL |
1 |
|
|
2.5 – 2.9 mg/dL |
2 |
|
|
2.0 – 2.4 mg/dL |
4 |
|
|
< 2 mg/dL |
8 |
|
serum prealbumin |
>= 15 mg/dL |
1 |
|
|
12.5 – 14.9 mg/dL |
2 |
|
|
10.0 – 12.4 mg/dL |
4 |
|
|
< 10 mg/dL |
8 |
|
negative nitrogen balance |
<= 5.0 grams lost per day |
1 |
|
|
5.1 – 10.0 grams lost per day |
2 |
|
|
10.1 – 15.0 grams lost per day |
4 |
|
|
> 15 grams lost per day |
8 |
where:
• The absolute lymphocyte counts in the original table overlap at the endpoints; the values above were adjusted to remove this.
• Delayed hypersensitivity testing is done with 4 antigens such as PPD, mumps, candida or trychophytin. Reactions are read 24-48 hours after intradermal injection based on the degree of erythema and induration. A area of induration >= 5 mm is considered positive.
• creatinine excretion index using a 24 hour urine collection = ((expected urine creatinine excretion in mg) / (actual urine creatinine excretion in mg)) * 100
• expected urine creatinine excretion for an adult male is 23 mg/kg ideal body weight; for an adult woman it is 18 mg/kg ideal body weight
• If not all of the data is available, then the subscore = SUM(points for items answered) / (number of items answered)
laboratory test subscore =
= SUM(points for laboratory test findings) / 9
PEMS score =
= (anthropometric subscore) + (clinical history subscore) + (physical examination subscore) + (laboratory test subscore)
Interpretation:
• minimum score: 4/4 for anthropometric, 4/4 for clinical history, 6/6 for physical examination, and 9/9 for laboratory test findings = 1 + 1 + 1 + 1 = 4.0
• maximum score: 32/4 for anthropometric, 32/4 for clinical history, 48/6 for physical examination, and 72/9 for laboratory test findings = 8 + 8 + 8 + 8 = 72
• The higher the PEMS score the greater the level of malnutrition.
• A surgical patient with a high PEMS score is at risk for post-operative complications.
Specialty: Nutrition
ICD-10: ,
