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Published on: September 20, 2019
Outcome of nutritional screening in the acute paediatric setting
P C Thomas1, L V Marino2, S A Williams1
1Child Health, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Insights
Nutritional screening tools like STAMP and PMST show poor accuracy in identifying pediatric malnutrition in acute care settings. Routine clinical assessment of weight, height, and intake is recommended over these tools.
Area of Science:
- Pediatric Nutrition
- Clinical Assessment
- Nutritional Epidemiology
Background:
- Limited data exists on the application of nutritional risk assessment tools in acute pediatric care.
- This study evaluates the validity of common screening tools in a tertiary children's hospital's acute unit.
Purpose of the Study:
- To explore the validity of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Paediatric Malnutrition Screening Tool (PMST) in an acute pediatric setting.
- To assess the nutritional status of a pediatric cohort using World Health Organization (WHO) definitions.
Main Methods:
- A prospective study involving 300 pediatric patients (median age 38 months).
- Standard anthropometry was measured, and patients were screened using STAMP, PMST, and the Paediatric Yorkhill Malnutrition Screening (PYMS) tool.
- Comparison of screening tool results against WHO malnutrition criteria.
Main Results:
- High percentages of children were identified at medium/high nutritional risk by STAMP (73.1%) and PMST (79.3%), while PYMS identified 30%.
- Prevalence of malnutrition included 3.4% stunted, 6.8% wasted (in children ≤5 years), and varying rates of overweight and obesity across age groups.
- Screening tools demonstrated poor specificity, variable sensitivity, and positive predictive values below 50% when compared to WHO criteria, with poor agreement indicated by kappa analysis.
Conclusions:
- Nutritional screening tools exhibit poor sensitivity and are challenging to interpret in the acute pediatric care setting.
- Routine clinical assessment, including weight, height, and nutritional intake evaluation during acute presentation, may be more effective than relying solely on screening tools to identify at-risk children.
Introduction:
Multiple nutritional risk assessment tools are available, but there are limited data on their application in the acute setting. We explored the validity of two tools in a tertiary Children's Hospital's acute unit and the cohort's nutritional status using WHO definitions.
Methods:
Prospective study n=300 (median 38 months; 44.6% female; 25.7% ≤12 months). Participants had standard anthropometry measured, all were screened using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), the Paediatric Malnutrition Screening Tool (PMST) (modified STAMP) and 125 were additionally screened using the Paediatric Yorkhill Malnutrition Screening (PYMS) tool.
Results:
The percentages with medium/high nutritional risk were as follows: STAMP 73.1%, PMST 79.3% and PYMS 30%. Height/weight were normally distributed with: 3.4% stunted (height-for-age z-score <-2); aged ≤ 5 years, 6.8% wasted (weight-for-height z-score (WHZ) <-2), 17.9% overweight (WHZ 1-2) and 6.2% obese (WHZ >2); aged >5 years, 5.8% thin (body mass index (BMI)-z-score (BAZ) <-2), 17.3% overweight (BAZ 1-2) and 5.8% obese (BAZ >2). The tools showed poor specificity and variable sensitivities when compared with WHO malnutrition criteria, with positive predictive values of <50%. κ-Analysis also showed poor agreement between the tools and the WHO cut-offs.
Conclusion:
These results suggest that nutritional screening tools have poor sensitivity and are difficult to interpret in the acute setting. It may be more effective to include the assessment of weight and height and nutritional intake in the context of the acute presentation as part of routine clinical assessment rather than relying on screening tools to identify those at risk.
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