Predictive Validity of the Academy of Nutrition and Dietetics/American Society for Parental Nutrition Indicators to Diagnose Malnutrition and the Screening Tool for Risk on Nutritional Status and Growth among Hospitalized Children Relative to Medical Outcomes

Abstract

ObjectiveTo evaluate predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators to diagnose pediatric malnutrition (AAIMp) and the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) in regard to pediatric patient outcomes in US hospitals. Study designA prospective cohort study (Clinical Trial Registry: NCT03928548) was completed from August 2019 through January 2023 with 27 pediatric hospitals or units from 18 US states and Washington DC. ResultsThree hundred and forty-five children were enrolled in the cohort (n=188 in the AAIMp validation subgroup). There were no significant differences in the incidence of emergency department (ED) visits and hospital readmissions, hospital length of stay (LOS), or healthcare resource utilization for children diagnosed with mild, moderate, or severe malnutrition using the AAIMp tool compared with children with no malnutrition diagnosis. The STRONGkids tool significantly predicted more ED visits and hospital readmissions for children at moderate and high malnutrition risk (moderate risk - incidence rate ratio [IRR] 1.65, 95% confidence interval [CI]: 1.09, 2.49, p = 0.018; high risk - IRR 1.64, 95% CI: 1.05, 2.56, p = 0.028) and longer LOS (43.8% longer LOS, 95% CI: 5.2%, 96.6%, p = 0.023) for children at high risk compared with children at low risk after adjusting for patient characteristics. ConclusionsMalnutrition risk based on the STRONGkids tool predicted poor medical outcomes in hospitalized US children; the same relationship was not observed for a malnutrition diagnosis based on the AAIMp tool.