The performance of STRONGkids in the early detection of hospital malnutrition
Abstract
Background Hospital malnutrition in children can increase morbidity and mortality, regardless of the type of illness. The Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) is a practical and easy nutritional risk screening tool that has been widely validated in several countries.
Objective To examine the performance of STRONGkids for the early detection of hospital malnutrition in pediatric inpatients.
Methods This cross-sectional study was conducted in the pediatric ward of Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia. The pediatric inpatients' STRONGkids scores were calculated within 24 hours of admission. We used the chi-square test to compare the proportion of at-risk children based on STRONGkids scores with the prevalence of hospital malnutrition based on serial weight measurement. We also determined the sensitivity, specificity, as well as positive and negative predictive values of STRONGkids for detecting hospital malnutrition, with percentage of weight loss between admission and discharge as the gold standard.
Result Out of 75 subjects, 48% were male. The hospital malnutrition prevalence was 29.3%. STRONGkids score was significantly associated with hospital malnutrition (P=0.023). The sensitivity, specificity, positive predictive value, and negative predictive value of STRONGkids for detecting hospital malnutrition was 77.3%, 54.7%, 41.4%, and 85.2%, respectively.
Conclusion With its good sensitivity, the STRONGkids tool is effective in identifying those at risk of hospital malnutrition. In addition, with its high NPV, a “no-risk” score also effectively implies that the child is likely not to have hospital malnutrition.
References
2. Juliaty A. Malnutrisi rumah sakit pada bangsal anak Rumah Sakit Dr. Wahidin Sudirohusodo Makassar. Sari Pediatr. 2013;15:65–8. DOI: https://doi.org/10.14238/sp15.2.2013.65-8. Indonesian.
3. Nasar S, Lestari ED, Susanto J, Djais J, Prawitasari T. Malnutrisi di rumah sakit. In: Sjarif DR, Lestari ED, Mexitalia M, Nasar SS, editors. Buku ajar nutrisi pediatrik dan penyakit metabolik. 2nd ed. Jakarta: Ikatan Dokter Anak Indonesia; 2014. p. 171–80. Indonesian.
4. Maryani E, Prawirohartono EP, Nugroho S. Faktor prediktor malnutrisi rumah sakit pada anak. Sari Pediatr. 2016;18:278–84. Indonesian.
5. Hecht C, Weber M, Grote V, Daskalou E, Dell'Era L, Flynn D, et al. Disease-associated malnutrition correlates with length of hospital stay in children. Clin Nutr. 2015;34:53–9. DOI: https://doi.org/10.1016/j.clnu.2014.01.003.
6. Girsang SN, Sidiartha IGL. The incidence of in-hospital malnutrition in children at Sanglah Hospital Denpasar and its association with length of stay. Medicina. 2017;48:98–102. DOI: https://doi.org/10.15562/medi.v48i2.35.
7. Cao J, Peng L, Li R, Chen Y, Li X, Mo B, et al. Nutritional risk screening and its clinical significance in hospitalized children. Clin Nutr. 2014;33:432–6. DOI: https://doi.org/10.1016/j.clnu.2013.06.009.
8. Maciel JRV, Nakano EY, de Carvalho KMB, Dutra ES. STRONGkids validation: tool accuracy. J Pediatr (Rio J). 2020;96:371-8. DOI: https://doi.org/10.1016/j.jped.2018.12.012.
9. Dos Santos CA, Ribeiro AQ, Rosa CDOB, de Araújo VE, Franceschini SDCC. Nutritional risk in pediatrics by STRONGkids: a systematic review. Eur J Clin Nutr. 2019;73:1441–9. DOI: https://doi.org/10.1038/s41430-018-0293-9.
10. M?rginean O, Pitea AM, Void?zan S, M?rginean C. Prevalence and assessment of malnutrition risk among hospitalized children in Romania. J Health Popul Nutr. 2014;32:97–102. PMID: 24847598.
11. Durakba?a ÇU, Fettaho?lu S, Bayar A, Mutus M, Okur H. The prevalence of malnutrition and effectiveness of STRONGkids tool in the identification of malnutrition risks among pediatric surgical patients. Balkan Med J. 2014;31:313–21. DOI: https://doi.org/10.5152/balkanmedj.2014.14374.
12. Moeeni V, Walls T, Day AS. Nutritional status and nutrition risk screening in hospitalized children in New Zealand. Acta Paediatr. 2013;102:419–23. DOI: 10.1111/apa.12299.
13. 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. DOI: https://doi.org/10.1016/j.nut.2013.05.008.
14. Hulst JM, Zwart H, Hop WC, Joosten KFM. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr. 2010;29:106–11. DOI: https://doi.org/10.1016/j.clnu.2009.07.006.
15. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415–21. DOI: https://doi.org/10.1016/S0261-5614(03)00098-0.
16. Sukhosa O, Kittisakmontri K. Prevalence of hospital malnutrition at admission and outcomes in pediatric patients. Int J Child Health Nutr. 2017;6:98–104. DOI: https://doi.org/10.6000/1929-4247.2017.06.03.2.
17. 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. DOI: https://doi.org/10.3390/ijerph8020514.
18. Wonoputri N, Djais JTB, Rosalina I. Validity of nutritional screening tools for hospitalized children. J Nutr Metab. 2014;2014:143649. DOI: https://doi.org/10.1155/2014/143649.
19. Sidiartha IGL. Insidens malnutrisi rawat inap pada anak balita di Rumah Sakit Umum Pusat Sanglah Denpasar. Sari Pediatr. 2008;9:381–5. DOI: https://doi.org/10.14238/sp9.6.2008.381-85.
20. Kac G, Camacho-Dias P, Silva-Coutinho D, Silveira-Lopes R, Marins VV, Pinheiro A. Length of stay is associated with incidence of in-hospital malnutrition in a group of low-income Brazillian children. Salud Publica Mex. 2000;42:407–12. DOI: https://doi.org/10.1590/s0036-36342000000500006.
21. Rocha GA, Rocha EJM, Martins CV. The effects of hospitalization on the nutritional status of children. J Pediatr (Rio J). 2006;82:70-4. DOI: https://doi.org/10.2223/JPED.1440.
22. Hartman C, Shamir R, Hecht C, Koletzko B. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metab Care. 2012;15:303–9. DOI: https://doi.org/10.1097/MCO.0b013e328352dcd4.
23. Sidiartha IGL, Pratiwi IGAPE. Implementation of STRONGkids in identify risk of malnutrition in government hospital. Int J Health Sci. 2018;2:18–24. DOI: https://doi.org/10.29332/ijhs.v2n2.117.
24. Ling RE, Hedges V, Sullivan PB. Nutritional risk in hospitalised children: an assessment of two instruments. ESPEN. 2011;6:153–7. DOI: https://doi.org/10.1016/j.eclnm.2011.01.007.
25. Moeeni V, Walls T, Day AS. The STRONGkids nutritional risk screening tool can be used by paediatric nurses to identify hospitalised children at risk. Acta Paediatr. 2014;103:528–31. DOI: https://doi.org/10.1111/apa.12768.
26. Joosten KFM, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr. 2008;20:590–6. DOI: https://doi.org/10.1097/MOP.0b013e32830c6ede.
27. 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;39:81. DOI: https://doi.org/10.1186/1824-7288-39-81.
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Accepted 2022-06-28
Published 2022-06-28