Thomas P C, Marino L V, Williams S A, Beattie R M
Child Health, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Department of Dietetics/SLT, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Arch Dis Child. 2016 Dec;101(12):1119-1124. doi: 10.1136/archdischild-2016-310484. Epub 2016 Sep 8.
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.
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.
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.
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.
有多种营养风险评估工具可供使用，但关于它们在急性病环境中的应用数据有限。我们在一家三级儿童医院的急性病科室探讨了两种工具的有效性，并根据世界卫生组织的定义评估了队列的营养状况。
前瞻性研究，n = 300（中位数38个月；44.6%为女性；25.7%年龄≤12个月）。对参与者进行标准人体测量，所有人均使用儿科营养不良评估筛查工具（STAMP）、儿科营养不良筛查工具（PMST，改良版STAMP）进行筛查，另外125人使用儿科约克希尔营养不良筛查（PYMS）工具进行筛查。
中/高营养风险的百分比分别如下：STAMP为73.1%，PMST为79.3%，PYMS为30%。身高/体重呈正态分布，具体情况为：3.4%发育迟缓（年龄别身高z评分<-2）；年龄≤5岁者，6.8%消瘦（身高别体重z评分（WHZ）<-2），17.9%超重（WHZ 1 - 2），6.2%肥胖（WHZ>2）；年龄>5岁者，5.8%体重过轻（体质指数（BMI）z评分（BAZ）<-2），17.3%超重（BAZ 1 - 2），5.8%肥胖（BAZ>2）。与世界卫生组织的营养不良标准相比，这些工具的特异性较差且敏感性各异，阳性预测值<50%。κ分析还表明，这些工具与世界卫生组织的临界值之间的一致性较差。
这些结果表明，营养筛查工具的敏感性较差，在急性病环境中难以解读。在急性病表现的背景下，将体重、身高和营养摄入量的评估纳入常规临床评估，而非依赖筛查工具来识别有风险的人群，可能会更有效。
