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Comparative evaluation of nutritional risk screening tools in hospitalized children with acute gastroenteritis
Yue Zhao1, Ziyang Li2, Mingyue Lin3
1Department of Nursing, Lianyungang Maternity and Child Health Hospital, Lianyungang, Jiangsu, China.
Insights
The Pediatric Malnutrition Screening Tool (PYMS) is most effective for identifying malnutrition in hospitalized children with acute gastroenteritis. This study found PYMS superior to STRONGkids and STAMP for early nutritional risk screening.
Area of Science:
- Pediatric Nutrition
- Gastroenterology
- Clinical Diagnostics
Background:
- Malnutrition is prevalent in children hospitalized for acute gastroenteritis.
- Optimal nutritional risk screening tools for this pediatric population are not well-defined.
- This study addresses the need for effective screening methods in this specific clinical context.
Purpose of the Study:
- To compare the diagnostic performance of STRONGkids, PYMS, and STAMP.
- To evaluate the clinical utility of these three tools in identifying malnutrition.
- To determine the most suitable screening tool for hospitalized children with acute gastroenteritis.
Main Methods:
- A multicenter retrospective study involving 855 children with acute gastroenteritis.
- Retrospective nutritional risk assessment using STRONGkids, PYMS, and STAMP.
- Receiver operating characteristic (ROC) curve analysis and decision curve analysis were employed.
Main Results:
- PYMS demonstrated the highest discriminatory performance (AUC=0.860), outperforming STAMP (AUC=0.796) and STRONGkids (AUC=0.717).
- PYMS showed superior sensitivity, specificity, and negative predictive value at its optimal cut-off.
- Decision curve analysis supported PYMS as having the greatest clinical utility.
Conclusions:
- The Pediatric Malnutrition Screening Tool (PYMS) is the most effective screening tool for malnutrition in hospitalized children with acute gastroenteritis.
- PYMS offers superior diagnostic performance and clinical utility compared to STRONGkids and STAMP.
- PYMS is recommended for early nutritional risk screening in this patient group.
Background:
Malnutrition is common in hospitalized children with acute gastroenteritis, yet the optimal nutritional risk screening tool for this population remains unclear. This study aimed to compare the diagnostic performance and clinical utility of STRONGkids, PYMS, and STAMP in identifying malnutrition among hospitalized children with acute gastroenteritis.
Methods:
In this multicenter retrospective study, children hospitalized with acute gastroenteritis between January 2024 and January 2026 were identified from electronic medical records at admission. After exclusions, 855 children were included in the final analysis. Nutritional risk was retrospectively assessed using STRONGkids, PYMS, and STAMP. Nutritional status was classified according to body mass index-for-age z scores based on the World Health Organization growth reference. Receiver operating characteristic curve analysis was used to evaluate discriminatory performance, with pairwise comparisons performed using the DeLong test. Optimal cut-off values were determined using the Youden index, and decision curve analysis was performed to assess clinical utility.
Results:
Of the 855 children included, 82 were malnourished and 773 had normal nutritional status. Compared with children with normal nutritional status, malnourished children were younger and had more vomiting and diarrhea episodes, longer hospital stay, higher screening scores, and more severe dehydration. PYMS showed the best discriminatory performance, with an AUC of 0.860 (95% CI, 0.824-0.896), followed by STAMP at 0.796 (95% CI, 0.748-0.845) and STRONGkids at 0.717 (95% CI, 0.658-0.776). PYMS performed significantly better than both STRONGkids and STAMP, and STAMP also outperformed STRONGkids. At the optimal cut-off of 3, PYMS had the highest sensitivity, specificity, Youden index, and negative predictive value. Decision curve analysis also supported the superior clinical utility of PYMS.
Conclusion:
Among the three screening tools, PYMS demonstrated the best overall performance for identifying malnutrition in hospitalized children with acute gastroenteritis and may be the most suitable tool for early nutritional risk screening in this population.
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