Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population.
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 (STRONGKIDS)] compared with and were related to anthropometric measures, body composition, and clinical variables in patients who were admitted to tertiary hospitals across Europe.


METHODS
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 STRONGKIDS: 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 STRONGKIDS: 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 (<-2) body mass index (BMI) SD-scores (SDSs), and 8% of them had low height-for-age SDSs. For the STAMP, the percentages were 19% and 14%, respectively, and for the STRONGKIDS, 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.
Ludwig-Maximilians-University of Munich, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany;
Michael
M
Chourdakis
Ludwig-Maximilians-University of Munich, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany;
Christina
C
Hecht
Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, Royal Hospital for Sick Children, University of Glasgow, Glasgow, United Kingdom;
Konstantinos
K
Gerasimidis
Erasmus Medical Center, Sophia Children's Hospital, Department of Pediatrics, Rotterdam, Netherlands;
Koen Fm
KF
Joosten
Clinical Nutrition Laboratory, Nutrition/Dietetics Department, Technological Education Institute, Thessaloniki, Greece;
Thomais
T
Karagiozoglou-Lampoudi
Beatrix Children's Hospital, University Hospital Groningen, Groningen, Netherlands;
Harma A
HA
Koetse
Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland;
Janusz
J
Ksiazyk
Clinic Pediatrics I, Clinical Emergency Hospital for Children, Cluj-Napoca (Klausenburg), Romania;
Cecilia
C
Lazea
Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and.
Raanan
R
Shamir
Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
Hania
H
Szajewska
Ludwig-Maximilians-University of Munich, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany; office.koletzko@med.uni-muenchen.de.
Berthold
B
Koletzko
Erasmus Medical Center, Sophia Children's Hospital, Department of Pediatrics, Rotterdam, Netherlands;
Jessie M
JM
Hulst
D001823:Body Composition; D015992:Body Mass Index; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002673:Child, Hospitalized; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology*; D015596:Nutrition Assessment; D009752:Nutritional Status; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors
PYMS; STAMP; STRONGKIDS; hospitalized children; malnutrition; nutritional screening