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Evaluation of an electronic medical record-based Paediatric Nutrition Screening Tool
Julia Hilbrands1, Mary Beth Feuling1, Aniko Szabo2
1Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA.
Insights
A new nutrition screening tool, incorporating the Paediatric Nutrition Screening Tool (PNST) and American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines, effectively identifies pediatric patients at risk for malnutrition with high sensitivity.
Area of Science:
- Pediatric Nutrition
- Clinical Screening Tools
- Malnutrition Identification
Background:
- Nutrition screening is crucial for identifying children at risk of malnutrition.
- A novel screening tool was developed integrating American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations.
- The tool was embedded within the electronic medical record for practical application.
Purpose of the Study:
- To evaluate the efficacy of a newly developed, integrated nutrition screening tool.
- To compare the performance of the new tool against the Paediatric Nutrition Screening Tool (PNST) alone.
- To assess the tool's ability to predict nutrition risk in hospitalized children.
Main Methods:
- Retrospective analysis of data from 1,575 pediatric patients admitted in 2019.
- Inclusion criteria: patients receiving a full nutrition assessment by a registered dietitian (RD).
- Data collected: nutrition screen results, diagnoses, nutrition status, and specific risk factors.
Main Results:
- The integrated tool demonstrated a sensitivity of 93.9% and a negative predictive value (NPV) of 89.8%.
- Factors significantly associated with malnutrition included positive screens, multiple food allergies, intubation, and parenteral nutrition.
- Compared to PNST alone (sensitivity 32%, specificity 94.2%), the new tool showed higher sensitivity.
Conclusions:
- The developed nutrition screening tool is effective in predicting nutrition risk in pediatric patients.
- The integrated tool offers superior sensitivity for identifying at-risk children compared to the PNST alone.
- This tool enhances early detection of malnutrition, facilitating timely nutritional interventions.
Background:
Nutrition screening is recommended to identify children at risk for malnutrition. A unique screening tool was developed based on American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations and embedded in the electronic medical record to assess for nutrition risk.
Methods:
The components of the tool included the Paediatric Nutrition Screening Tool (PNST) and other elements recommended by ASPEN. To evaluate the screening tool, retrospective data were analysed on all patients admitted to acute care units of Children's Wisconsin in 2019. Data collected included nutrition screen results, diagnosis and nutrition status. All patients who received at least one full nutrition assessment by a registered dietitian (RD) were included in analysis.
Results:
One thousand five hundred seventy-five patients were included in analysis. The following screen elements were significantly associated with a diagnosis of malnutrition: any positive screen (p < 0.001), >2 food allergies (p = 0.009), intubation (p < 0.001), parenteral nutrition (p = 0.005), RD-identified risk (p < 0.001), positive risk per the PNST (p < 0.001), BMI-for-age or weight-for-length z-score (p < 0.001), intake <50% for 3 days (p = 0.012) and NPO > 3 days (p = 0.009). The current screen had a sensitivity of 93.9%, specificity of 20.3%, positive predictive value (PPV) of 30.9% and negative predictive value (NPV) of 89.8%. This is compared with the PNST which had a sensitivity of 32%, specificity of 94.2%, PPV of 71% and NPV of 75.8% in this study population.
Conclusion:
This unique screening tool is useful for predicting nutrition risk and has a greater sensitivity than the PNST alone.
