Screening for nutritional risk in hospitalized children: comparison of two instruments

Main Article Content

Dwi Novianti
Tiangsa Sembiring
Sri Sofyani
Tri Faranita
Winra Pratita


Background Malnutrition in hospitalized children has negative impact on morbidity, mortality, length of stay, and health-care cost. A simple screening tool is needed to detect hospital malnutrition risk in children.

Objective To compare the level of agreement of the Screening Tool for Malnutrition in Pediatrics (STAMP) and Pediatric Nutritional Risk Score (PNRS) with anthropometric measurements, as screening tools for hospital malnutrition in children.

Methods A cross-sectional study was conducted from February to July 2014 in the Pediatric and Surgery Wards at H. Adam Malik Hospital, Medan, North Sumatera. Inclusion criteria were children aged 2 to 18 years who were hospitalized for more than 72 hours. Subjects were screened using STAMP and PNRS, and underwent anthropometric measurement on admission. The weight measurements were repeated on the 3rd and 7th days, and just before discharge. The STAMP and PNRS results were compared in terms of level of agreement with anthropometric measurements. Data were analyzed by Kappa value and Spearman’s correlation test.

Results A total of 127 children were screened with both instruments. The PNRS had slight agreement with hospital malnutrition prevalence (κ=0.175; P=0.028), while STAMP had not  (κ=0.080; P=0.193). Both screening tools had weak positive correlations with length of stay, but the correlation was stronger for PNRS than for STAMP (r=0.218; P=0.014 vs. r=0.188; P=0.034, respectively). The prevalence of hospital malnutrition was 40.9%.

 Conclusions The PNRS screening tool has slight agreement with anthropometric measurement for identifying hospital malnutrition risk in children.

Article Details

How to Cite
Novianti D, Sembiring T, Sofyani S, Faranita T, Pratita W. Screening for nutritional risk in hospitalized children: comparison of two instruments. PI [Internet]. 22Jun.2017 [cited 20Oct.2018];57(3):117-3. Available from:
Author Biographies

Dwi Novianti, University of Sumatera Utara

Department of Child Health, Medical School, University of Sumatera Utara

Tiangsa Sembiring, University of Sumatera Utara

Department of Child Health, Medical School, University of Sumatera Utara

Sri Sofyani, University of Sumatera Utara

Department of Child Health, Medical School, University of Sumatera Utara

Tri Faranita, University of Sumatera Utara

Department of Child health, Medical School, University of Sumatera Utara

Winra Pratita, University of Sumatera Utara

Department of Child Health, Medical School, University of Sumatera Utara


1. Nasar SS, Susanto JC, Lestari ED, Djais J, Prawitasari T. Malnutrisi rumah sakit. In: Sjarif DR, Lestari ED, Mexitalia M, Nasar SS, editors. Buku ajar nutrisi pediatrik dan penyakit metabolik. Volume 1. Jakarta: Ikatan Dokter Anak Indonesia; 2011. p. 165-76.
2. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5-15.
3. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8:514-27.
4. Pawellek I, Dokoupil K, Koletzko B. Prevalence of malnutrition in paediatric hospital patients. Clin Nutr. 2008;27:72-6.
5. Puryatni A, Ramadan N, Yanuar. Incidence of hospital malnutrition at pediatric ward Saiful Anwar Hospital. In: Lubis B, Ali M, Yanni GN, Trisnawati Y, Ramayani OR, Irsa L, et al., editors. Kumpulan naskah lengkap Pertemuan Ilmiah Tahunan Ilmu Kesehatan Anak ke-4; Medan: USU Press; 2010. p. 108.
6. Nesal NNM, Sidiartha GL, Prawirohartono EP, Suandi KG. Accuracy of modified simple pediatric nutritional risk score to detect in-hospital malnutrition. Paediatr Indones. 2010;50:305-9.
7. Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, Brusset MC, Mosser F, Berrier F, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr. 2000;72:64-70.
8. 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 (STAMP) for use by healthcare staff. J Hum Nutr Diet. 2012;25:311-18.
9. World Health Organization Technical Report Series 854. Physical status: the use and interpretation of anthropometry. Geneva: WHO Expert Committee; 1995. p. 161-262.
10. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 CDC growth charts for the United States: methods and development. National Center for Health Statistics. Vital Health Stat. 2002;11:1-190.
11. Waterlow JC. Classification and definition of protein-calorie malnutrition. Br Med J. 1972;3:566-9.
12. Bailey B, Gravel J, Daoust R. Reliability of visual analog scale in children with acute pain in the emergency department. Pain. 2012;153:839-42.
13. Central Manchester University Hospitals NHS Foundation Trust. Screening tool for the assessment of malnutrition in paediatrics. [cited 2012 April]. Available from:
14. Wiskin AE, Owens DR, Cornelius VR, Wootton SA, Beattie RM. Pediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. J Hum Nutr Diet. 2012;25:319-22.
15. 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.
16. Wonoputri N, Djais JT, Rosalina I. Validity of nutritional screening tools for hospitalized children. J Nutr Metab. 2014;15:1-6.
17. Ling RE, Hedges V, Sullivan PB. Nutritional risk in hospitalized children: an assessment of two instruments. e-SPEN, the Eur e-J of Clin Nutr and Metab. 2011;6:e153-7.
18. Okoromah CA, Ekure EN, Lesi FEA, Okunowo WO, Tijani BO, Okeiyi JC. Prevalence, profile and predictors of malnutrition in children with congenital heart defects: a case-control observational study. Arch Dis Child. 2011;96:354-60
19. Kyle UG, Coss-Bu JA. Nutritional assessment and length of hospital stay. CMAJ. 2010;182:1831-2
20. Amaral TF, Matos LC, Tavares MM, Subtil A, Martins R, Nazare M, et al. The economic impact of disease-related malnutrition at hospital admission. Clin Nutr. 2007;26:778-84.