Nutritional screening in hospitalized pediatric patients: a systematic review

Teixeira, Adriana Fonseca; Viana, Kátia Danielle Araújo Lourenço

doi:10.1016/j.jped.2015.08.011

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Review articles • J. Pediatr. (Rio J.) 92 (4) • Jul-Aug 2016 • https://doi.org/10.1016/j.jped.2015.08.011 copy

Nutritional screening in hospitalized pediatric patients: a systematic review^☆ ☆ Please cite this article as: Teixeira AF, Viana KD. Nutritional screening in hospitalized pediatric patients: a systematic review. J Pediatr (Rio J). 2016;92:343–52. ,^☆☆ ☆☆ Study associated with the Multidisciplinary Residency Program in Health, Hospital Universitário, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

This systematic review aimed to verify the available scientific evidence on the clinical performance and diagnostic accuracy of nutritional screening tools in hospitalized pediatric patients.

Data source:

A search was performed in the Medline (National Library of Medicine United States), LILACS (Latin American and Caribbean Health Sciences), PubMed (US National Library of Medicine National Institutes of Health), in the SCIELO (Scientific Electronic Library Online), through CAPES portal (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), bases Scopus e Web of Science. The descriptors used in accordance with the Descriptors in Health Sciences (DeCS)/Medical Subject Headings (MeSH) list were “malnutrition”, “screening”, and “pediatrics”, as well as the equivalent words in Portuguese.

Summary of the findings:

The authors identified 270 articles published between 2004 and 2014. After applying the selection criteria, 35 were analyzed in full and eight articles were included in the systematic review. We evaluated the methodological quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Five nutritional screening tools in pediatrics were identified. Among these, the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) showed high sensitivity, almost perfect inter-rater agreement and between the screening and the reference standard; the Screening Tool Risk on Nutritional Status and Growth (STRONGkids) showed high sensitivity, lower percentage of specificity, substantial intra-rater agreement, and ease of use in clinical practice.

Conclusions:

The studies included in this systematic review showed good performance of the nutritional screening tools in pediatrics, especially STRONGkids and STAMP. The authors emphasize the need to perform for more studies in this area. Only one tool was translated and adapted to the Brazilian pediatric population, and it is essential to carry out studies of tool adaptation and validation for this population.

Keywords
Screening; Malnutrition; Pediatrics; Systematic review

Author/year	Screening	Place	Population	Objective	Sample	Age range	Reference standard used
Gerasimidis et al./2010²⁸28 Gerasimidis K, Keane O, Macleod I, Flynn DM, Wright CM. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr. 2010;104:751-6.	PYMS	United Kingdom	Clinical and surgical patients	To assess the diagnostic accuracy of the new Pediatric Yorkhill Malnutrition Score (PYMS)	247	1–16 years	Anthropometric measurements, body composition and dietary measures
Huysentruyt et al./2013⁴⁴44 Huysentruyt K, Alliet P, Muyshont L, Rossignol R, Devreker T, Bontems P, et al. The STRONGkids nutritional screening tool in hospitalized children: a validation study. Nutrition. 2013;29:1356-61.	STRONGkids	Belgium	Clinical and surgical patients	Test the easy handling and reproducibility of STRONGkids to confirm the validity in a Belgian population of hospitalized children	368	4 months to 15.5 years	Anthropometrics (HFA < −2SD and WFH < −2SD)
Lama More et al./2012⁴¹41 Lama More RA, López AM, Álvarez MH, Chicano C, Martínez RG, Ruzafa EL. Validación de una herramienta de cribado nutricional para pacientes pediátricos hospitalizados. Nutr Hosp. 2012;27:1429-36.	STAMP	Spain	Clinical and surgical patients	Validate the pediatric nutritional screening tool STAMP for a Spanish population	250	1 month to 18 years	Specialized nutritional assessment (clinical, anthropometric, body composition)
McCarthy et al./2012⁴⁰40 McCarthy H, Dixon M, Crabtree I, Eaton-Evans MJ, McNulty H. The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMPª) for use by healthcare staff. J Hum Nutr Diet. 2012;25:311-8.	STAMP	United Kingdom	Clinical and surgical patients	Develop and evaluate a nutritional screening to be used by the nursing staff in the early identification of malnutrition in hospitalized children	122	2–17 years	Full nutritional assessment by a nutritionist
Spagnuolo et al./2013⁵5 Spagnuolo MI, Liguoro I, Chiatto F, Mambretti D, Guarino A. Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting. Ital J Pediatr. 2013;39:1-7.	STRONGkids	Italy	Clinical and surgical patients	To investigate the efficacy of the STRONGkids screening tool in a population of children admitted to 12 Italian hospitals	144	1–18 years	Anthropometrics (HFA < −2SD and BMI < −2SD)
Wong et al./2012⁴²42 Wong S, Graham A, Harini SP, Grimble G, Forbes A. Validation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) in patients with spinal cord injuries (SCIs). Spinal Cord. 2012;51:424-9.	STAMP	United Kingdom	Patients with spinal trauma	Validate the STAMP screening tool in pediatric patients with spinal injuries admitted to the National Center for Spinal Trauma	51	6 months to 18 years	Full dietary assessment (clinical, nutritional, and biochemical)
Wonoputri et al./2014⁴³43 Wonoputri N, Djais JT, Rosalina I. Validity of nutritional screening tools for hospitalized children. J Nutr Metab. 2014;2014:1-6.	STAMP; STRONGkids; PYMS	Indonesia	Clinical patients	Verify the concurrent validity between the three nutritional screening tools in comparison to the Subjective Global Assessment of Nutrition (SGNA)	116	1–15 years	SGNA
White et al./2014²⁹29 White M, Lawson K, Ramsey R, Dennis N, Hutchinson Z, Soh XY, et al. A simple nutrition screening tool for pediatric inpatients. J Parenter Enteral Nutr. 2014;20:1-7.	PNST; SGNA	Australia	Clinical and surgical patients	Report the accuracy of a new, quick and simple Pediatric Nutrition Screening Tool (PNST) designed to be used in pediatric patients	295	1–16 years	Anthropometrics and SGNA

Author/year	Screening	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Agreement (Kappa)
Gerasimides et al./2010²⁸28 Gerasimidis K, Keane O, Macleod I, Flynn DM, Wright CM. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr. 2010;104:751-6.	PYMS	59	92	47	95	AR: k = 0.46 (95% CI 0.27–0.64) Inter-observer: k = 0.53 (95% CI 0.38–0.67)

Huysentruyt et al./2013⁴⁴44 Huysentruyt K, Alliet P, Muyshont L, Rossignol R, Devreker T, Bontems P, et al. The STRONGkids nutritional screening tool in hospitalized children: a validation study. Nutrition. 2013;29:1356-61.	STRONGkids	71.9^a a Reference standard: acute malnutrition (WFH < −2SD).	49.1^a a Reference standard: acute malnutrition (WFH < −2SD).	11.9^a a Reference standard: acute malnutrition (WFH < −2SD).	94.8^a a Reference standard: acute malnutrition (WFH < −2SD).	Inter-observer: k = 0.61
	STRONGkids	69^b b Reference standard: chronic malnutrition (HFA < −2SD).	48.4^b b Reference standard: chronic malnutrition (HFA < −2SD).	10.4^b b Reference standard: chronic malnutrition (HFA < −2SD).	94.8^b b Reference standard: chronic malnutrition (HFA < −2SD).	Intra-observer: k = 0.66

Lama More et al./2012⁴¹41 Lama More RA, López AM, Álvarez MH, Chicano C, Martínez RG, Ruzafa EL. Validación de una herramienta de cribado nutricional para pacientes pediátricos hospitalizados. Nutr Hosp. 2012;27:1429-36.	STAMP	75	60.8	39.7	87.6	Inter-observer: k = 0.85

McCarthy et al./2012⁴⁰40 McCarthy H, Dixon M, Crabtree I, Eaton-Evans MJ, McNulty H. The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMPª) for use by healthcare staff. J Hum Nutr Diet. 2012;25:311-8.	STAMP	70 (95% CI 51–84)	91 (95% CI 86–94)	54.8 (95% CI 38.8–69.8)	94.9 (95% CI 90.5–97.4)	AR: k = 0.882 (95% CI 0.646–1.000) Inter-observer: k = 0.921 (95% CI 0.763–1.000)

Spagnuolo et al./2013⁵5 Spagnuolo MI, Liguoro I, Chiatto F, Mambretti D, Guarino A. Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting. Ital J Pediatr. 2013;39:1-7.	STRONGkids	71 (95% CI 48–89)	53 (95% CI 43–63)	21 (95% CI 17–25)	85 (95% CI 85–90)	–

Wong et al./2012⁴²42 Wong S, Graham A, Harini SP, Grimble G, Forbes A. Validation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) in patients with spinal cord injuries (SCIs). Spinal Cord. 2012;51:424-9.	STAMP	83.3	66.7	78.1	73.6	AR: k = 0.507 (95% CI 0.646–1.000) Inter-observer: k = 0.752 Intra-observer: k = 0.635

Wonoputri et al./2014⁴³43 Wonoputri N, Djais JT, Rosalina I. Validity of nutritional screening tools for hospitalized children. J Nutr Metab. 2014;2014:1-6.	PYMS	95.31 (95% CI 0.87–0.98)	76.92 (95% CI 0.63–0.86)	83.56 (95% CI 0.73–0.9)	93.02 (95% CI 0.81–0.97)	AM: k = 0.348 (95% CI 0.191–0.506) CM: k = 0.125 (95% CI 0–0.299)
	STAMP	100 (95% CI 0.94–1)	11.54 (95% CI 0.05–0.23)	58.2 (95% CI 0.48–0.67)	100 (95% CI 0.61–1)	AM: k = 0.018 (95% CI 0–0.140) CM: k = 0 (95% CI 0–0.140)
	STRONGkids	100 (95% CI 0.94–1)	7.7 (95% CI 0.03–0.18)	57.14 (95% CI 0.479–0.659)	100 (95% CI 0.51–1)	AM: k = 0.028 (95% CI 0–0.149) CM: k = 0 (95% CI 0–0.144)

White et al./2014²⁹29 White M, Lawson K, Ramsey R, Dennis N, Hutchinson Z, Soh XY, et al. A simple nutrition screening tool for pediatric inpatients. J Parenter Enteral Nutr. 2014;20:1-7.	PNST	89.3^c c Reference standard: BMI ≤ −2SD.	66.2^c c Reference standard: BMI ≤ −2SD.	22.5^c c Reference standard: BMI ≤ −2SD.	98.4^c c Reference standard: BMI ≤ −2SD.	–
	PNST	77.8^d d Reference standard: SGNA.	82.1^d d Reference standard: SGNA.	69.3^d d Reference standard: SGNA.	87.6^d d Reference standard: SGNA.
	SGNA	96.5	72.5	27.7	99.5	–

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[1] * Corresponding author. adrianaf.teixeira@hotmail.com (A.F. Teixeira).