Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting

Italian Journal of Pediatrics

Alfredo Guarino¹  Daniela Mambretti¹  Fabrizia Chiatto¹  Ilaria Liguoro¹  Maria Immacolata Spagnuolo¹ 

[1] Department of Translational Medical Science – Section of Pediatrics, University of Naples “Federico II”, Naples, Italy

关键词: Chronic disease;    Screening tool;    Hospital malnutrition;    Children;    Pediatrics;   

Others  :  812275
DOI  :  10.1186/1824-7288-39-81

 received in 2013-08-29, accepted in 2013-12-17,  发布年份 2013

【 摘 要 】

Background

An increased but unpredictable risk of malnutrition is associated with hospitalization, especially in children with chronic diseases. We investigated the applicability of Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), an instrument proposed to estimate the risk of malnutrition in hospitalized children. We also evaluated the role of age and co-morbidities as risk for malnutrition.

Methods

The STRONGkids consists of 4 items providing a score that classifies a patient in low, moderate, high risk for malnutrition. A prospective observational multi-centre study was performed in 12 Italian hospitals. Children 1–18 years consecutively admitted and otherwise unselected were enrolled. Their STRONGkids score was obtained and compared with the actual nutritional status expressed as BMI and Height for Age SD-score.

Results

Of 144 children (75 males, mean age 6.5 ± 4.5 years), 52 (36%) had an underlying chronic disease. According to STRONGkids, 46 (32%) children were at low risk, 76 (53%) at moderate risk and 22 (15%) at high risk for malnutrition. The latter had significantly lower Height for Age values (mean SD value -1.07 ± 2.08; p = 0.008) and BMI values (mean SD-values -0.79 ± 2.09; p = 0.0021) in comparison to other groups. However, only 29 children were actually malnourished.

Conclusions

The STRONGkids is easy to administer. It is highly sensitive but not specific. It may be used as a very preliminary screening tool to be integrated with other clinical data in order to reliably predict the risk of malnutrition.

【 授权许可】

   
2013 Spagnuolo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kruizenga HM, Tulder MWV, Seidell JC: Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr 2005, 82:1082-1089.
• [2]Baldwin C, Parson TJ: Dietary advice and nutrition supplements in the management of illness-related malnutrition: a systematic review. Clin Nutr 2004, 23:1267-1279.
• [3]Hoffer LJ: Clinical Nutrition: 1. Protein-energy malnutrition in the inpatient. Can Med Assoc J 2001, 165:1345-1349.
• [4]Braunschweig C, Gomez S, Sheean PM: Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days. J Am Diet Assoc 2000, 100:1316-1322.
• [5]Holmes S: The effects of undernutrition in hospitalised patients. Nurs Stand 2007, 22:35-38.
• [6]Kubrack C, Jensen L: Malnutrition in acute care patients. Int J Nurs Stud 2007, 44:1036-1054.
• [7]Correia MI, Waitzberg DL: The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003, 22:235-239.
• [8]Joosten KF, Hulst JM: Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr 2008, 20:590-596.
• [9]Dogan Y, Erkan T, Yalvac S, et al.: Nutritional status of patients hospitalized in pediatric clinic. Turk J Gastroenterol 2005, 16:212-216.
• [10]Marteletti O, Caldari D, Guimber D, et al.: Malnutrition screening in hospitalized children: influence of the hospital unit on its management. Arch Pediatr 2005, 12:1226-1231.
• [11]Moy R, Smallman S, Booth I: Malnutrition in a UK children’s hospital. J Hum Nutr Diet 1990, 3:93-100.
• [12]Pawellek I, Dokoupil K, Koletzko B: Prevalence of malnutrition in paediatric hospital patients. Clin Nutr 2008, 27:72-76.
• [13]Joosten KF, Zwart H, Hop WC, et al.: National malnutrition screening days in hospitalized children in the Netherlands. Arch Dis Child 2010, 95:141-145.
• [14]Campanozzi A, Russo M, Catucci A, Rutigliano I, Canestrino G, Giardino I, Romondia A, Pettoello-Mantovani M: Hospital-acquired malnutrition in children with mild clinical conditions. Nutrition 2009, 25:540-547.
• [15]Aurangzeb B, Whitten KE, Harrison B, et al.: Prevalence of malnutrition and risk of under-nutrition in hospitalized children. Clin Nutr 2012, 31:35-40.
• [16]Hartman C, Shamir R: Basic clinical assessment of pediatric malnutrition. Ann Nestle Eng 2009, 67:55-63.
• [17]Hartman C, Shamir R, Hecht C, Koletzko B: Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metab Care 2012, 15:303-309.
• [18]Hulst JM, Zwart H, Hop WC, et al.: Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr 2010, 29:106-111.
• [19]Sandhu BK, Fell JME, Beattie RM: Guidelines for the management of inflammatory bowel disease in children in the United Kingdom. J Pediatr Gastroenterol Nutr 2010, 50(suppl1):S1-S13.
• [20]Wiskin AE, Owens DR, Cornelius VR, et al.: Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. J Hum Nutr Diet 2012, 25:319-322.
• [21]Cacciari E, Milani S, Balsamo A, et al.: Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Invest 2006, 29:581-593.
• [22]Cole TJ, Flegal KM, Nicholls D, et al.: Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 2007, 335:194.
• [23]WHO: Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva: World Health Organization; 1999.
• [24]Skillman HE, Wischmeyer PE: Nutrition therapy in critically ill infants and children. J Parenteral Enteral Nutr 2008, 32:520-534.
• [25]López-Herce Cid J, Sánchez Sánchez C, Mencía Bartolomé S, et al.: Energy expenditure in critically ill children: correlation with clinical characteristics, caloric intake, and predictive equations. An Pediatr (Barc) 2007, 66:229-239.
• [26]Mosby TT: Almost a fifth of children admitted to Dutch hospitals have acute or chronic malnutrition; risk factors include underlying disease and non-white ethnicity. Evid Based Nurs 2010, 13:81-82.
• [27]Barton SH, Kelly DG, Murray JA: Nutritional deficiencies in celiac disease. Gastroenterol Clin North Am 2007, 36:93-108.
• [28]Ling RE, Hedges V, Sullivan PB: Nutritional risk in hospitalized children: an assessment of two instruments. E-SPEN 2011, 6:e153-e157.
• [29]McCarthy H, Dixon M, Crabtree I, et al.: The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) for use by healthcare staff. J Hum Nutr Diet 2012, 25:311-318.
• [30]Hendricks KM, Duggar C, Gallagher L, et al.: Malnutrition in hospitalized pediatric patients. Current prevalence. Arch Pediatr Adolesc Med 1995, 149:1118-1122.
• [31]Joosten KF, Hulst JM: Malnutrition in pediatric hospital patients: current issues. Nutrition 2011, 27:133-137.
• [32]Secker DJ, Jeejeebhoy KN: Subjective global nutritional assessment for children. Am J Clin Nutr 2007, 85:1083-1089.
• [33]Secker DJ, Jeejeebhoy KN: How to perform Subjective Global Nutritional assessment in children. J Acad Nutr Diet 2012, 112:424-431.
• [34]Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V: Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr 2000, 72:64-70.
• [35]Gerasimidis K, Keane O, Macleod I, et al.: A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr 2010, 19:1-6.
• [36]Modena V, Walls T, Day AS: Nutritional status and nutrition risk screening in hospitalized children in New Zealand. Acta Paediatr 2013, 102:e419-e423.