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Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) in the Electronic Health Record: A Validation
Michelle Reed1, Kathleen Mullaney2, Christy Ruhmann1
1Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA.
Insights
The new electronic health record-compatible malnutrition screening tool for pediatrics (EHR-STAMP) accurately identifies hospitalized children at nutrition risk. This validated tool improves upon existing methods for early malnutrition detection in acute care settings.
Area of Science:
- Pediatric Nutrition
- Clinical Informatics
- Healthcare Quality Improvement
Background:
- Malnutrition significantly impacts pediatric patients in acute care, leading to poorer clinical outcomes.
- Effective nutrition screening is crucial for early identification and management of malnutrition.
- Existing pediatric nutrition screening tools lack electronic health record (EHR) compatibility and updated indicators.
Purpose of the Study:
- To validate a modified version of the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) for EHR integration, termed EHR-STAMP.
- To incorporate updated pediatric malnutrition indicators into the screening tool.
- To assess the reliability and performance of the EHR-STAMP.
Main Methods:
- An interprofessional team adapted the STAMP tool for seamless EHR integration.
- The modified tool underwent iterative audits by a research dietitian for accuracy assessment and design refinement.
- The final EHR-STAMP version was evaluated on 3553 pediatric inpatients.
Main Results:
- The EHR-STAMP demonstrated progressively improved accuracy, sensitivity, and specificity through modifications.
- The final EHR-STAMP achieved 85% accuracy, 89% sensitivity, and 97% specificity.
- The tool reported a positive predictive value of 60% and a negative predictive value of 94%.
Conclusions:
- The EHR-STAMP is a highly reliable and validated tool for screening nutrition risk in hospitalized pediatric patients.
- The tool is user-friendly, compatible with EHR systems, and includes current recommended indicators for pediatric malnutrition assessment.
- Implementation of EHR-STAMP can enhance early detection and management of malnutrition in pediatric acute care.
Background:
The impact of malnutrition on pediatric patients in the acute care setting is significant. Hospitalized patients with malnutrition have been shown to have poor clinical outcomes. Nutrition screening is the first critical step in identifying and treating malnutrition. Although several pediatric nutrition screening tools exist, none incorporate both electronic health record (EHR) compatibility and the recommended indicators of pediatric malnutrition, a gap recently identified in a systematic review by the Academy of Nutrition and Dietetics. The aim of this study was to prove the validity of a new version of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), EHR-STAMP, modified for incorporation into the EHR and inclusion of updated pediatric malnutrition indicators.
Methods:
An interprofessional team modified the existing STAMP for integration into the EHR. Audits were performed by the research dietitian to assess accuracy and provide feedback for continuous improvement of the tool design.
Results:
A total of 3553 pediatric inpatients were studied from August 2017 to May 2019. Accuracy, sensitivity, and specificity improved with each modification to the EHR-STAMP. The final version of the EHR-STAMP found 85% accuracy, 89% sensitivity, and 97% specificity, with a positive predictive value of 60% and a negative predictive value of 94%.
Conclusion:
The EHR-STAMP is a highly reliable tool in the screening of nutrition risk for pediatric hospitalized patients. The tool is easy to use, EHR compatible, and incorporates the current indicators recommended for assessing pediatric malnutrition.
