Department of Agricultural, Life, and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada.
Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada.
Nutr Clin Pract. 2020 Oct;35(5):951-958. doi: 10.1002/ncp.10367. Epub 2019 Jul 9.
Identifying children at malnutrition risk on admission to hospital is considered best practice; however, nutrition screening in pediatric populations is not common. The aim of this study was to determine which screening tool is able to identify children with malnutrition on admission to hospital.
A nurse administered 2 pediatric nutrition screening tools, Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) and Pediatric Nutrition Screening Tool (PNST) to patients admitted to medicine and surgery units (n = 165). The Subjective Global Nutritional Assessment (SGNA) was then completed by a dietitian, blinded to the results of the screens. Sensitivity, specificity, and κ were calculated for both screening tools against the SGNA. A receiver operating characteristic (ROC) curve assessed alternate cutoffs for each tool. Length of hospital stay (LOS) was used to assess prospective validity.
Using the recommended cutoffs, the sensitivity of STRONGkids was 89%, specificity 35%, and κ 0.483. The sensitivity of PNST was 58%, specificity 88%, and κ 0.601. Using adjusted cutoffs, PNST's sensitivity improved to 87%, specificity 71%, and κ 0.681, and STRONGkids specificity improved to 61%, sensitivity 80%, and κ 0.5. Children identified at nutrition risk had significantly longer LOS (P < 0.05).
This study showed neither tool was appropriate for clinical use based on published cutoffs. By adjusting the cutoffs using ROC curve analysis, both tools improved overall agreement with the SGNA without significantly impacting the prospective validity. PNST with adjusted cutoffs is the most appropriate for clinical use in this population.
在入院时识别营养不良风险的儿童被认为是最佳实践；然而，儿科人群中的营养筛查并不常见。本研究的目的是确定哪种筛查工具能够在入院时识别营养不良的儿童。
护士对内科和外科病房的 165 名患者进行了两种儿科营养筛查工具，即营养状况和生长风险筛查工具（STRONGkids）和儿科营养筛查工具（PNST）的评估。然后，营养师根据主观整体营养评估（SGNA）对患者进行评估，该营养师对筛查结果不知情。针对 SGNA 计算了两种筛查工具的灵敏度、特异性和κ。接收者操作特征（ROC）曲线评估了每个工具的替代截止值。住院时间（LOS）用于评估前瞻性有效性。
使用推荐的截止值，STRONGkids 的灵敏度为 89%，特异性为 35%，κ 值为 0.483。PNST 的灵敏度为 58%，特异性为 88%，κ 值为 0.601。使用调整后的截止值，PNST 的灵敏度提高到 87%，特异性提高到 71%，κ 值提高到 0.681，而 STRONGkids 的特异性提高到 61%，灵敏度提高到 80%，κ 值提高到 0.5。被确定为营养风险的儿童的 LOS 显著延长（P<0.05）。
本研究表明，根据已发表的截止值，两种工具均不适合临床使用。通过使用 ROC 曲线分析调整截止值，两种工具在不显著影响前瞻性有效性的情况下，提高了与 SGNA 的整体一致性。使用调整后的截止值的 PNST 是该人群中最适合临床使用的工具。
