Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Emergency department (ED) food insecurity (FI) screening traditionally identifies insufficient access to food but does not account for diet quality. We evaluated the incremental yield of adding a nutrition insecurity (NI) screener to routine FI screening.

Methods: This single-center observational study enrolled adult ED patients from April–September 2025. Participants completed the 2-item Hunger Vital Sign and a 1-item NI screener. Our primary measure was incremental yield of NI screening beyond FI screening, defined by the number of NI-positive/FI-negative patients identified. Secondary outcome measures included FI and NI prevalence, screening concordance, and number needed to screen. Screening fidelity was supported through structured training of research associates and standardized phrasing.

Results: Of 1,120 patients, 13.6% (95% CI, 11.6–15.7%) screened positive for FI and 11.4% (95% CI, 9.7–13.5%) for NI. While the measures showed substantial agreement (κ = 0.67), they identified significantly different populations (McNemar P = .01). Specifically, 28 patients (2.5%) screened NI-positive but FI-negative, yielding an 18.4% relative increase in identified at-risk patients compared to only screening for FI.

Conclusion: Dual screening identified a clinically relevant NI-only subgroup whose diet-quality barriers were not captured by FI screening alone. Incorporating NI into ED social needs assessments may improve identification of diet-related risk and guide medically tailored interventions.