Nutr Res Pract.  2019 Oct;13(5):410-414. 10.4162/nrp.2019.13.5.410.

Comparison of four nutritional screening tools for Korean hospitalized children

• Lee YJ
• Yang HR

• KMID: 2464120
• DOI: http://doi.org/10.4162/nrp.2019.13.5.410

Abstract

BACKGROUND/OBJECTIVES
Several nutritional screening tools were recently developed to screen the risk of malnutrition in hospitalized children, but have not been validated in Asia. We compared four nutritional screening tools for pediatric patients in evaluating nutritional risks in newly hospitalized children.
SUBJECTS/METHODS
Medical records of newly admitted pediatric patients between June 2016 and May 2017 at two tertiary hospitals were reviewed. Initial information by nurses and hospital records by doctors on baseline demographic, clinical, and anthropometric data at admission were collected in all subjects. Nutritional risks were evaluated using four nutritional screening tools including the pediatric nutritional risk score (PNRS), the screening tool for the assessment of malnutrition in pediatrics (STAMP), the paediatric Yorkhill malnutrition score (PYMS), and the screening tools for risk of nutritional status and growth (STRONGkids).
RESULTS
A total of 559 patients (310 boys and 249 girls, mean age 6.3 ± 5.5 years) were recruited. Patients in medical and surgical departments were 469 (83.9%) and 90 (16.1%), respectively. The prevalence of patients at risk of malnutrition were 31.1% for low risk, 52.2% for medium risk, and 16.6% for high risk by PNRS; 11.4%, 39.7%, and 48.8% by STAMP; 26.5%, 25.4%, and 48.1% by PYMS; and 35.6%, 58.9%, and 5.5% by STRONGkids. PNRS versus STRONGkids and STAMP versus PYMS showed moderate agreement (kappa = 0.566 and kappa = 0.495, respectively). PYMS and STAMP revealed a relatively high sensitivity of 87.8% and 77.6% for wasting.
CONCLUSION
Different nutritional screening tools revealed considerably different results in evaluating nutritional risks in newly hospitalized children. Since pediatric patients are at risk of malnutrition at admission and during hospitalization, screening tools should be applied properly according to the situation of each hospital.

Keyword

Malnutrition; hospital; risk; screening; child

MeSH Terms

Asia
Child
Child, Hospitalized*
Female
Hospital Records
Hospitalization
Humans
Malnutrition
Mass Screening*
Medical Records
Nutritional Status
Pediatrics
Prevalence
Tertiary Care Centers

Figure

• 

  Fig. 1 Agreement between each nutritional screening tool. Agreement between each nutritional screening tool by Cohen's kappa coefficient in 559 hospitalized children showed moderate agreement between PNRS versus STRONGkids and STAMP versus PYMS. PNRS, pediatric nutritional risk score; STAMP, screening tool for the assessment of malnutrition in pediatrics; PYMS, paediatric Yorkhill malnutrition score; STRONGkids, screening tool for risk of nutritional status and growth.

Reference

1. Joosten KF, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr. 2008; 20:590–596.

2. Mărginean O, Pitea AM, Voidăzan S, Mărginean C. Prevalence and assessment of malnutrition risk among hospitalized children in Romania. J Health Popul Nutr. 2014; 32:97–102.

3. Chourdakis M, Hecht C, Gerasimidis K, Joosten KF, Karagiozoglou-Lampoudi T, Koetse HA, Ksiazyk J, Lazea C, Shamir R, Szajewska H, Koletzko B, Hulst JM. Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population. Am J Clin Nutr. 2016; 103:1301–1310.

4. Nasab MH, Gholampour Z, Imani B, Norouzy A. Prevalence of malnutrition risk based on three nutritional risk scores in hospitalized Iranian children. Int Res J Appl Basic Sci. 2016; 10:438.

5. Hwang EH, Park JH, Chun P, Lee YJ. Prevalence and risk factors for the weight loss during hospitalization in children: a single Korean children's hospital experience. Pediatr Gastroenterol Hepatol Nutr. 2016; 19:269–275.

6. Lee DG, Rho YI, Moon KR. Assessment of nutritional status in hospitalized pediatric patients. Korean J Pediatr Gastroenterol Nutr. 2001; 4:83–91.

7. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003; 22:415–421.

8. Reilly HM, Martineau JK, Moran A, Kennedy H. Nutritional screening--evaluation and implementation of a simple nutrition risk score. Clin Nutr. 1995; 14:269–273.

9. Detsky AS, Baker JP, Mendelson RA, Wolman SL, Wesson DE, Jeejeebhoy KN. Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. JPEN J Parenter Enteral Nutr. 1984; 8:153–159.

10. Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: the mini nutritional assessment as part of the geriatric evaluation. Nutr Rev. 1996; 54:S59–S65.

11. Durán Alert P, Milà Villarroel R, Formiga F, Virgili Casas N, Vilarasau Farré C. Assessing risk screening methods of malnutrition in geriatric patients: mini nutritional assessment (MNA) versus geriatric nutritional risk index (GNRI). Nutr Hosp. 2012; 27:590–598.

12. Abd Aziz NAS, Teng NIMF, Abdul Hamid MR, Ismail NH. Assessing the nutritional status of hospitalized elderly. Clin Interv Aging. 2017; 12:1615–1625.

13. Håkonsen SJ, Pedersen PU, Bath-Hextall F, Kirkpatrick P. Diagnostic test accuracy of nutritional tools used to identify undernutrition in patients with colorectal cancer: a systematic review. JBI Database System Rev Implement Rep. 2015; 13:141–187.

14. Lee YJ. Nutritional screening tools among hospitalized children: from past and to present. Pediatr Gastroenterol Hepatol Nutr. 2018; 21:79–85.

15. Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, Brusset MC, Mosser F, Berrier F, Ricour C. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr. 2000; 72:64–70.

16. Secker DJ, Jeejeebhoy KN. Subjective global nutritional assessment for children. Am J Clin Nutr. 2007; 85:1083–1089.

17. Gerasimidis K, Keane O, Macleod I, Flynn DM, Wright CM. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr. 2010; 104:751–756.

18. Hulst JM, Zwart H, Hop WC, Joosten KF. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr. 2010; 29:106–111.

19. McCarthy H, Dixon M, Crabtree I, Eaton-Evans MJ, McNulty H. The development and evaluation of the screening tool for the assessment of malnutrition in paediatrics (STAMP©) for use by healthcare staff. J Hum Nutr Diet. 2012; 25:311–318.

20. White M, Lawson K, Ramsey R, Dennis N, Hutchinson Z, Soh XY, Matsuyama M, Doolan A, Todd A, Elliott A, Bell K, Littlewood R. Simple nutrition screening tool for pediatric inpatients. JPEN J Parenter Enteral Nutr. 2016; 40:392–398.

21. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, Oh K, Jang MJ, Hwang SS, Yoo MH, Kim YT, Lee CG. 2007 Korean national growth charts: review of developmental process and an outlook. Korean J Pediatr. 2008; 51:1–25.

22. Thomas PC, Marino LV, Williams SA, Beattie RM. Outcome of nutritional screening in the acute paediatric setting. Arch Dis Child. 2016; 101:1119–1124.