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Validation of a Nutrition Screening Tool in Critically Ill Children
Anna Burneske1, Collin Ellenbecker2, Evelyn Kuhn3
1Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Insights
A new nutrition screening tool was developed for critically ill children in the pediatric intensive care unit (PICU). This tool helps identify malnutrition, which is common and linked to worse outcomes in these vulnerable patients.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Healthcare informatics
Background:
- Malnutrition is a significant issue in pediatric intensive care units (PICUs), often worsening during a patient's stay.
- Malnutrition in critically ill children is associated with increased mortality and longer PICU length of stay.
- Existing nutritional screening tools are not specifically designed for the unique needs of critically ill children.
Purpose of the Study:
- To develop and validate a novel nutrition screening tool tailored for critically ill children.
- To address the gap in specialized nutritional assessment tools for the pediatric intensive care unit (PICU) population.
- To refine and validate this tool across a diverse group of critically ill children in multiple US PICUs.
Main Methods:
- A prospective study involving 732 subjects across six PICUs.
- Subjects underwent a novel nutrition screen and a Subjective Global Nutritional Assessment (SGNA).
- Statistical analyses, including chi-square, Mann-Whitney tests, and stepwise logistic regression, were used to identify key indicators and develop a predictive model.
Main Results:
- 17.9% of enrolled subjects were identified as malnourished by SGNA.
- Key factors for the screening tool included weight-for-age percentile, cancer diagnosis, reduced feeding, poor parental perception of growth, and being underweight.
- A scoring system was developed to define a positive screen, indicating a need for dietitian referral.
Conclusions:
- A validated nutrition screening tool for critically ill children in the PICU has been successfully developed.
- This tool can aid in the early identification of malnutrition in this vulnerable patient population.
- The tool aims to improve nutritional management and potentially patient outcomes in the PICU.
Abstract:
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.
