Screening for nutrition risk in children: the validation of a new tool

Abstract

Background: The importance of the early identification and management of nutritional risk is well established in adult and elderly hospital care. Numerous nutritional screening tools are available for adults, for example Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA) and NRS‐2002 (Kondrup et al., 2003). Currently there is no validated nutrition risk screening tool for use with children admitted to hospital in the UK. The aim of this study was to test the validity of a newly developed nutrition risk screening tool for children.Methods: All children (aged 2–17 years) admitted to the study wards (two medical, two surgical) over a 4 week period were screened using a newly developed, nurse administered paediatric nutrition screening tool (NST). The NST consisted of three elements – clinical diagnosis, nutritional intake and anthropometric measures. Each element was scored and children with an overall score of three or more were considered at nutritional risk. Of those screened, a sample (n = 89) were further assessed for full nutritional status by a registered dietitian. The full nutritional assessment consisted of a face‐to‐face interview obtaining dietary and social information, anthropometric measurements and retrieval of medical information from case notes. Data were analysed using chi‐square tests to compare groups within the sample and k statistic to compare agreement between the full nutritional assessment and NST. Full ethical approval was obtained prior to undertaking this study.Results: The majority of 89 participants were surgical admissions (58%), male (56%) and the mean (SD) age was 9.0 (4.5) years. Nutritional risk was identified in 21% of the sample using the NST, and in 20% of the sample by full nutritional assessment. The prevalence of nutritional risk was not significantly different between methods or between males and females (by either method), but was statistically higher (by both methods) in medical compared with surgical admissions (χ2 = 18.426, P < 0.001; χ2 = 7.139, P = 0.008 respectively). Compared to the full nutritional assessment, the NST demonstrated 72% sensitivity and 90% specificity and a k statistic (95% CI) of 0.599 (0.39, 0.81) (Table 1). Agreement between full nutritional assessment and the nutrition screening tool (NST) NST At nutrition risk (n) Not at nutrition risk (n) Full nutritional assessment At nutrition risk 13 5 Not at nutrition risk 7 64 Discussion: This study validated the use of a newly developed, nurse administered nutrition risk screening tool for children, utilising information normally obtained by nursing staff during the admission process thereby requiring little additional training. The tool demonstrated good agreement with a full nutritional assessment by a registered dietitian, indicating that it would be effective in the early identification of children at nutritional risk.Conclusion: The results suggest that this new nutrition risk screening tool is valid and reliable for the identification of children requiring further nutritional assessment and appropriate intervention. Further investigation will focus on the malnutrition risk by different clinical conditions.Reference Kondrup, J., Allison, J.P., Elia, M., Vellas, B. & Plauth, M. (2003) ESPEN Guidelines for nutrition screening 2002.Clin. Nutr.22, 415–421.