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Published on: September 18, 2018
Reproducibility and Inter-rater Reliability of 2 Paediatric Nutritional Screening Tools
Rafael Galera-Martínez1, Ana Moráis-López, Maria Del C Rivero de la Rosa
1*On behalf of GETNI (Grupo Español de Trabajo en Nutrición Infantil) †Complejo Hospitalario Torrecárdenas, Almería ‡Hospital Universitario La Paz, Madrid §Hospital Universitario Virgen Macarena, Sevilla ||IIS Aragón, Hospital Clínico Universitario Lozano Blesa Zaragoza ¶Hospital Infantil Universitario Miguel Servet, Zaragoza #Centro Médico D-Medical, Madrid, Spain.
Objectives:
The aim of the present study was to assess reproducibility and inter-rater reliability of 2 nutritional screening tools (NST): Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) and Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP).
Methods:
Prospective observational multicentre study. Patients ages 1 month or older admitted to paediatric or surgical wards were tested within 24 hours of admission by 2 independent observers: experts specialized in paediatric nutrition (physicians or dieticians) and clinical staff nonexpert in nutrition. Diagnosis on admission, underlying diseases, and length of stay were registered.
Statistical Analysis:
Kappa index (κ) to evaluate agreement between observers.
Results:
A total of 223 patients were included (53.4% boys), with mean age of 5.59 (95% confidence interval 4.94-6.22) years. Experts classified 9.9% of patients at high risk with STRONGkids and 19.7% using STAMP, whereas nonexpert staff assigned 6.7% of patients to the high-risk category with STRONGkids and 21.9% with STAMP. Agreement between expert and nonexpert staff was good: 94.78% for STRONGkids (κ 0.72 [P < 0.001]); 92.55% for STAMP (κ 0.74 [P < 0.001]). The rate of malnutrition was significantly higher among high-risk patients with both NST, independent of examiner experience. After adjusting for age, both STRONGkids and STAMP high-risk scores predicted longer length of stay, whether assessed by experts or nonexperts, although differences were higher with STRONGkids.
Conclusions:
Agreement between experts and nonexpert staff in nutrition was good, producing a similar high-risk patient profile. Our results demonstrate that these NSTs are appropriate for nutritional screening in settings in which users have no previous experience in the field.
