Outcome of nutritional screening in the acute paediatric setting.
BACKGROUND
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.
Child Health, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
P C
PC
Thomas
Department of Dietetics/SLT, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
L V
http://orcid.org/0000-0002-1257-121X
LV
Marino
Child Health, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
S A
SA
Williams
Child Health, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
R M
RM
Beattie
D000208:Acute Disease; D000886:Anthropometry / Q000379:methods; D015362:Child Nutrition Disorders / Q000175:diagnosis*; D002675:Child, Preschool; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status / Q000502:physiology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods
malnutrition; nutrition risk; screening tools