Nutrition Risk Assessed by STRONGkids Predicts Longer Hospital Stay in a Pediatric Cohort: A Survival Analysis

Abstract

Background We evaluated the impact of Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) classification in time to discharge and verify whether the nutrition risk assessed by this method is an independent predictor of hospital length of stay (LOS) in pediatric inpatients. Methods A cohort study was conducted in a Brazilian hospital from February 2014 to July 2018. The outcome in the survivor analysis was hospital discharge. Kaplan‐Meier curves were used to estimate the cumulative survival time according to STRONGkids categories. Multivariable Cox proportional hazard models were fitted, and the adjusted hazard ratio (aHR), with respective 95% CI, was used to measure the strength of association. The discriminatory ability of STRONGkids was verified by a receiver operating characteristic curve Results A total 641 patients were included in the study: 54.9% males, median age of 2.8 years. The frequencies of low, moderate, and high nutrition risk were 15.6%, 63.7%, and 20.7%, respectively. The mean LOS was 5.9 days. Survival curves differed significantly according to nutrition‐risk categories. Patients classified as high risk had a 52% less chance of hospital discharge when compared with low‐risk patients (aHR: 0.48; 95% CI, 0.35–0.65). STRONGkids score ≥ 3 showed the best discriminatory power to identify LOS. From this score, there was a significant increase in the days of hospitalization. Conclusion The nutrition risk assessed by STRONGkids independently predicts LOS in pediatric patients. For this outcome, patients with 3 points (moderate risk) should be treated with the same priority as those with high risk.

Increased nutrition risk at admission is associated with longer hospitalization in children and adolescents with COVID‐19

“…Pediatric nutrition risk scores have been used to identify children and adolescents who are likely to develop further nutrition deterioration during hospitalization and the need for a strict monitoring of their nutrition clinical status to prevent poor outcomes. STRONGkids was incorporated by many hospitals in the world to evaluate nutrition risk in children and adolescents and may help determine the best plan of care for these patients 22,23 …”

“…STRONGkids was incorporated by many hospitals in the world to evaluate nutrition risk in children and adolescents and may help determine the best plan of care for these patients. 22 , 23 …”

“…STRONGkids was incorporated by many hospitals in the world to evaluate nutrition risk in children and adolescents and may help determine the best plan of care for these patients. 22,23 Studies have shown a significant relationship of STRONGkids with current nutrition status 24 and outcome defined as LOS. Hulst et al 11 showed that, in children with various clinical diagnoses, a lower STRONGkids risk score was associated with a significantly shorter LOS when compared with that of children with a moderate or higher risk score (median 2 days vs 3 days, respectively; P < 0.001).…”

Nutritional risk and clinical outcomes of COVID-19 in hospitalized children and adolescents: a multicenter cohort

“…Zamberlan and colleagues 11 observed an association between longer hospital stays with higher nutritional risk assessed by STRONGkids, in children and adolescents with COVID-19, where STRONGkids ≥ 4 points was related to a later discharge date ( p = 0.0107). The association between high nutritional risk and lower chance of hospital discharge has already been described in another study 20 that evaluated 641 Brazilian individuals, in the period from 2014 to 2018. The relationship between high nutritional risk and length of hospital stay, in studies with patients hospitalized with COVID-19, is still scarce.…”