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Development and Validation of a Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score to Predict Nutritional
Suchaorn Saengnipanthkul1, Prapassara Sirikarn2, Nalinee Chongviriyaphan3
1Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand.
Insights
A new Pediatric Hospital-Acquired Malnutrition (PHaM) risk score effectively predicts nutritional decline in children. This tool aids early intervention for better outcomes in hospitalized pediatric patients.
Area of Science:
- Pediatric Nutrition
- Clinical Risk Assessment
- Hospital Medicine
Background:
- Hospital-acquired malnutrition is a significant issue in pediatric patients, leading to adverse health outcomes.
- Early identification of children at risk for nutritional deterioration is crucial for timely intervention.
Purpose of the Study:
- To develop and validate a risk score for predicting hospital-acquired malnutrition in pediatric patients.
- The Pediatric Hospital-Acquired Malnutrition (PHaM) risk score aims to identify children likely to experience nutritional decline.
Main Methods:
- A retrospective cohort study developed the PHaM risk score using data from 444 pediatric patients.
- Logistic regression identified predictors including gastrointestinal symptoms, disease severity, and reduced intake.
- Validation was performed on an independent prospective cohort of 373 patients.
Main Results:
- The PHaM risk score demonstrated good predictive ability (AUC 0.852) in the development cohort.
- The score showed high sensitivity (91.9%) and negative predictive value (93.0%) in the validation cohort.
- Key predictors identified were gastrointestinal symptoms, disease severity, fever, lower respiratory tract infection, and reduced food intake.
Conclusions:
- The PHaM risk score is a novel and effective tool for predicting nutritional deterioration in hospitalized children.
- Implementation of this score can improve nutritional care and optimize patient outcomes.
- The score aids in proactive management of pediatric nutritional status during hospitalization.
Abstract:
(1) Background: Hospital-acquired malnutrition in pediatric patients leads to adverse outcomes. This study aimed to develop and validate a pediatric hospital-acquired malnutrition (PHaM) risk score to predict nutritional deterioration. (2) Methods: This was a derivative retrospective cohort study for developing a PHaM risk score. The study included data from children aged 1 month-18 years admitted to pediatric wards in four tertiary care hospitals for at least 72 h between December 2018 and May 2019. Data on pediatric patients' characteristics, medical history, nutritional status, gastrointestinal symptoms, and outcomes were used for tool development. Logistic regression identified risk factors for nutritional deterioration, defined as a decline in BMI z-score ≥ 0.25 SD and/or ≥2% weight loss. A PHaM risk score was developed based on these factors and validated with an independent prospective cohort from July 2020 to March 2021. (3) Results: The study used a derivative cohort of 444 patients and a validation cohort of 373 patients. Logistic regression identified gastrointestinal symptoms, disease severity, fever, lower respiratory tract infection, and reduced food intake as predictors. The PHaM risk score (maximum 9 points) showed good discrimination and calibration (AUC 0.852, 95% CI: 0.814-0.891). Using a cut-off at 2.5 points, the scale had 63.0% sensitivity, 88.6% specificity, 76.1% positive predictive value, and 80.6% negative predictive value (NPV) when applied to the derivative cohort. The accuracy improved on the validation cohort, with 91.9% sensitivity and 93.0% NPV. (4) Conclusions: This PHaM risk score is a novel and probably effective tool for predicting nutritional deterioration in hospitalized pediatric patients, and its implementation in clinical practice could enhance nutritional care and optimize outcomes.
