Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population

Abstract

Background: Several malnutrition screening tools have been advocated for use in pediatric inpatients. Objective: We evaluated how 3 popular pediatric nutrition screening tools [i.e., the Pediatric Yorkhill Malnutrition Score (PYMS), the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and the Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONG KIDS )] compared with and were related to anthropometric measures, body composition, and clinical variables in patients who were admitted to tertiary hospitals across Europe. Design: The 3 screening tools were applied in 2567 inpatients at 14 hospitals across 12 European countries. The classification of patients into different nutritional risk groups was compared between tools and related to anthropometric measures and clinical variables [e.g., length of hospital stay (LOS) and infection rates]. Results: A similar rate of completion of the screening tools for each tool was achieved (PYMS: 86%; STAMP: 84%; and STRONG KIDS : 81%). Risk classification differed markedly by tool, with an overall agreement of 41% between tools. Children categorized as high risk (PYMS: 25%; STAMP: 23%; and STRONG KIDS : 10%) had a longer LOS than that of children at low risk (1.4, 1.4, and 1.8 d longer, respectively; P , 0.001). In high-risk patients identified with the PYMS, 22% of them had low (,22) body mass index (BMI) SDscores (SDSs), and 8% of them had low height-for-age SDSs. For the STAMP, the percentages were 19% and 14%, respectively, and for the STRONG KIDS , the percentages were 23% and 19%, respectively. Conclusions: The identification and classification of malnutrition risk varied across the pediatric tools used. A considerable portion of children with subnormal anthropometric measures were not identified with all of the tools. The data obtained do not allow recommending the use of any of these screening tools for clinical practice. This study was registered at clinicaltrials.gov as NCT01132742. Am J Clin Nutr 2016;103:1301-10.

Hospital Malnutrition in Pediatric Patients: A Review

“…Also, the tools failed to identify some malnourished patients, but the authors found a significant association between risk of malnutrition and longer hospital stays. For these reasons, the authors concluded that no nutritional risk screening tool available today can be indicated for routine use in pediatric hospitals [49].…”

Outcome of nutritional screening in the acute paediatric setting

“…Chourdakis et al 18 found that risk classification varied with tools and concluded that they were unable to recommend the current tools for use in clinical practice. In their study they only considered children who scored as high risk to be at risk and found that on a number of occasions those with subnormal BMI were not identified by the tools 18.…”

“…In their study they only considered children who scored as high risk to be at risk and found that on a number of occasions those with subnormal BMI were not identified by the tools 18. We, however, considered those who scored either medium or high risk to be at risk in our analysis, as those who were medium risk required ongoing monitoring and would be expected to pick up children with a suboptimal BMI who did not score as high risk.…”

“…Recent international studies clearly described an association between malnutrition, increased hospital stay and complications, recommending timely identification and nutrition management to improve patient outcome 1 18. Despite this, there has been very little research, or evidence, that the use of current screening tools improve outcomes in those identified as being at risk and, as such further, work is required 5…”

“…A recent meta-analysis of nutrition screening tools also showed that there is ‘marked variation between studies’ including reference tests or gold standards used to validate the tools 8. This has been further supported by a large multicentre study of STAMP, PYMS and STRONGkids tools which found variation in the identification and classification of malnutrition by the tools, as well as poor identification of children who, by anthropometric standards, were malnourished 18. There are also issues around ease of use, implementation and reproducibility within a clinical setting, where even standard anthropometry, particularly height/length, is not always recorded,3 19 suggesting that the measurement and interpretation of growth may not be embedded in routine clinical practice.…”