Waterlow Criteria, Age and Diagnosis Identify Nutritional Risk in Pediatric Patients

Abstract

LEARNING OUTCOME: To describe factors that identify nutritional risk in pediatric patients.We sought to develop an improved model for a hospitalwide screening program and to determine the risk factors for malnutrition in a pediatric population by comparing the effectiveness of our current screening tool to that of Waterlow criteria. All patients (n = 645) admitted to a tertiary-care pediatric hospital during a 2-week period were screened using both tools. Information obtained by the screening tool included sex, age, diagnosis, gastrointestinal (GI) problems, appetite, albumin, hemoglobin, weight and height, with weight being the primary risk indicator due to lack of height measurements. The anthropometric values were determined from height and weight measurements using ANTHRO from the World Health Organization. The screening tool found an 11% prevalence of malnutrition (acute and/or chronic). Waterlow criteria indicated malnutrition in 44% of patients with acute and chronic malnutrition in 20% and 31% of patients, respectively. The sensitivity of the established screening tool, compared with Waterlow criteria, was 20%, and the specificity was 96%. Waterlow criteria found a greater number of patients at nutritional risk by identifying children with chronic malnutrition/linear stunting. Factors that helped identify nutritional risk were age, diagnosis and anthropometries. Information of less value in assessing nutritional risk included a history of weight loss, poor appetite, GI problems and/or albumin levels. The results of this study were used to modify the existing screening tool and to increase compliance in obtaining admission anthropometries to more accurately and efficiently identify patients at nutritional risk.