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Mechanical Ventilation Boot Camp Curriculum
Published on: March 12, 2018
Performance of different nutrition risk screening tools in predicting malnutrition in critically ill children on
Ning Li1,2, Jing Chen1, Xiuxiu Lu1
1Department of Critical Care Medicine, Capital Institute of Pediatrics, Capital Center for Children's Health, Capital Medical University, Beijing, China.
Insights
Nutrition risk screening in critically ill children on mechanical ventilation is crucial. The STRONGkids and PYMS tools effectively predict malnutrition and mortality, guiding better clinical outcomes.
Area of Science:
- Pediatric critical care medicine
- Nutritional science
- Clinical epidemiology
Background:
- Critically ill children on mechanical ventilation face significant nutritional challenges.
- Understanding nutrition status and risk is vital for improving outcomes in this population.
- Existing tools for nutrition risk assessment require evaluation in this specific cohort.
Purpose of the Study:
- To characterize nutrition status and risk in mechanically ventilated children.
- To evaluate the predictive accuracy of different nutrition risk screening tools.
- To assess the association between nutrition risk and clinical outcomes.
Main Methods:
- A comparison study included 375 critically ill children requiring mechanical ventilation (≥24 hours).
- Nutrition status assessed by BMI z-score; risk evaluated using Paediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and STRONGkids.
- Clinical data, including outcomes, were extracted from electronic health records.
Main Results:
- 20.6% of children had moderate-to-severe malnutrition, higher in those on invasive ventilation.
- STRONGkids and PYMS showed high accuracy in predicting malnutrition (AUC 0.90 and 0.86, respectively).
- Higher nutrition risk correlated with longer ventilation, increased ICU stay, higher costs, and worse outcomes.
Conclusions:
- The STRONGkids and PYMS tools demonstrate significant predictive value for malnutrition and mortality in pediatric mechanical ventilation.
- These validated tools can aid in early identification and management of at-risk children.
- Optimizing nutrition interventions based on risk stratification may improve clinical outcomes.
Background:
This study aimed to characterize the distribution of nutrition status and nutrition risk stratification in critically ill children undergoing mechanical ventilation and to evaluate the association of nutrition risk with their clinical outcomes.
Methods:
This comparison study included 375 critically ill children receiving mechanical ventilation (invasive or noninvasive, duration ≥24 h). Nutrition status at admission was evaluated using body mass index z score, and nutrition risk was assessed via three validated tools: Paediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk on Nutritional Status and Growth (STRONGkids). Clinical data were extracted from electronic records.
Results:
Three hundred seventy-five critically ill children undergoing mechanical ventilation were enrolled (207 boys, 168 girls; median age, 8 [2-26.5] months), with 246 receiving invasive and 129 noninvasive ventilation; 20.6% had moderate-severe malnutrition (59.7% in invasive ventilation). All tools identified >60% at high risk. STRONGkids (area under the curve [AUC], 0.90) and PYMS (AUC, 0.86) better predicted malnutrition than STAMP (AUC, 0.74). STRONGkids (AUC, 0.89) outperformed in mortality prediction. Higher risk correlated with longer ventilation/pediatric intensive care unit stay, higher costs, and worse outcomes (P < 0.05). Multivariate analysis showed malnutrition, clinical diagnosis, and lactate level as independent risk factors and no organ dysfunction, healthy serum prealbumin level, and healthy serum albumin level as protective factors.
Conclusion:
PYMS and STRONGkids demonstrated high predictive value for moderate-to-severe malnutrition and mortality in children undergoing mechanical ventilation.
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