Validation of a Nutrition Screening Tool in Critically Ill Children

Background/Objectives: Malnutrition is prevalent among patients in the pediatric intensive care unit (PICU) and has been shown to worsen in some patients during the PICU stay. In critically ill children, malnutrition is associated with longer PICU length of stay and increased mortality. Several tools have been developed and validated to screen for nutritional status in children, but none were specifically designed for critically ill children. Our study aims to fill this gap. The goal of this study was to refine and validate a novel PICU nutrition screening tool in a diverse population of critically ill children from six PICUs across the United States. Methods: Subjects underwent the nutrition screen and a Subjective Global Nutritional Assessment (SGNA). We used chi-square tests and Mann-Whitney tests to compare elements of the nutrition screen to the SGNA to identify those elements most associated with malnutrition. We used stepwise logistic regression to determine the best fitting model for a malnutrition screening tool. We proposed a scoring system using the factors identified in the best fitting model to define a positive screen. Results: We enrolled 732 subjects at six PICUs. Of these, 131 subjects (17.9%) were malnourished per the SGNA. Children with and without malnutrition did not differ with respect to age, sex, or race. The likelihood of malnutrition increased as weight-for-age percentile decreased (p < 0.001). We found that the best fitting model of a malnutrition screening tool for critically ill children included weight-for-age percentile, cancer, feeding less, parent perception of growth as poor, and being significantly underweight. We defined a positive screen that should prompt referral to a dietitian. Conclusions: We have developed a nutrition screening tool for critically ill children.