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Outcome of nutritional screening in the acute paediatric setting

Outcome of nutritional screening in the acute paediatric setting
Outcome of nutritional screening in the acute paediatric setting
Introduction: multiple nutritional risk assessment tools are available, but there are limited data on their application in the acute setting. We explored the validity of two tools in a tertiary Children's Hospital's acute unit and the cohort's nutritional status using WHO definitions.

Methods: prospective study n=300 (median 38 months; 44.6% female; 25.7% ≤12 months). Participants had standard anthropometry measured, all were screened using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), the Paediatric Malnutrition Screening Tool (PMST) (modified STAMP) and 125 were additionally screened using the Paediatric Yorkhill Malnutrition Screening (PYMS) tool.
Results: the percentages with medium/high nutritional risk were as follows: STAMP 73.1%, PMST 79.3% and PYMS 30%. Height/weight were normally distributed with: 3.4% stunted (height-for-age z-score <-2); aged ≤ 5 years, 6.8% wasted (weight-for-height z-score (WHZ) <-2), 17.9% overweight (WHZ 1-2) and 6.2% obese (WHZ >2); aged >5 years, 5.8% thin (body mass index (BMI)-z-score (BAZ) <-2), 17.3% overweight (BAZ 1-2) and 5.8% obese (BAZ >2). The tools showed poor specificity and variable sensitivities when compared with WHO malnutrition criteria, with positive predictive values of <50%. κ-Analysis also showed poor agreement between the tools and the WHO cut-offs.

Conclusions: these results suggest that nutritional screening tools have poor sensitivity and are difficult to interpret in the acute setting. It may be more effective to include the assessment of weight and height and nutritional intake in the context of the acute presentation as part of routine clinical assessment rather than relying on screening tools to identify those at risk.
0003-9888
1119-1124
Thomas, P.C.
260a29e1-369d-4578-a3df-0e3ba5346608
Marino, L.V.
c479400f-9424-4879-9ca6-d81e6351de26
Williams, S.A.
b710551e-c477-4ff1-8629-0c859ab8bd7a
Beattie, R.M.
9a66af0b-f81c-485c-b01d-519403f0038a
Thomas, P.C.
260a29e1-369d-4578-a3df-0e3ba5346608
Marino, L.V.
c479400f-9424-4879-9ca6-d81e6351de26
Williams, S.A.
b710551e-c477-4ff1-8629-0c859ab8bd7a
Beattie, R.M.
9a66af0b-f81c-485c-b01d-519403f0038a

Thomas, P.C., Marino, L.V., Williams, S.A. and Beattie, R.M. (2016) Outcome of nutritional screening in the acute paediatric setting. Archives of Disease in Childhood, 101 (12), 1119-1124. (doi:10.1136/archdischild-2016-310484).

Record type: Article

Abstract

Introduction: multiple nutritional risk assessment tools are available, but there are limited data on their application in the acute setting. We explored the validity of two tools in a tertiary Children's Hospital's acute unit and the cohort's nutritional status using WHO definitions.

Methods: prospective study n=300 (median 38 months; 44.6% female; 25.7% ≤12 months). Participants had standard anthropometry measured, all were screened using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), the Paediatric Malnutrition Screening Tool (PMST) (modified STAMP) and 125 were additionally screened using the Paediatric Yorkhill Malnutrition Screening (PYMS) tool.
Results: the percentages with medium/high nutritional risk were as follows: STAMP 73.1%, PMST 79.3% and PYMS 30%. Height/weight were normally distributed with: 3.4% stunted (height-for-age z-score <-2); aged ≤ 5 years, 6.8% wasted (weight-for-height z-score (WHZ) <-2), 17.9% overweight (WHZ 1-2) and 6.2% obese (WHZ >2); aged >5 years, 5.8% thin (body mass index (BMI)-z-score (BAZ) <-2), 17.3% overweight (BAZ 1-2) and 5.8% obese (BAZ >2). The tools showed poor specificity and variable sensitivities when compared with WHO malnutrition criteria, with positive predictive values of <50%. κ-Analysis also showed poor agreement between the tools and the WHO cut-offs.

Conclusions: these results suggest that nutritional screening tools have poor sensitivity and are difficult to interpret in the acute setting. It may be more effective to include the assessment of weight and height and nutritional intake in the context of the acute presentation as part of routine clinical assessment rather than relying on screening tools to identify those at risk.

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More information

Accepted/In Press date: 24 July 2016
e-pub ahead of print date: 8 September 2016

Identifiers

Local EPrints ID: 418822
URI: http://eprints.soton.ac.uk/id/eprint/418822
ISSN: 0003-9888
PURE UUID: e2b69d77-75ba-49a7-8970-04a44859f864

Catalogue record

Date deposited: 23 Mar 2018 17:30
Last modified: 06 Oct 2020 22:32

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