Pediatric Nutritional screening Tools for use in Hospitalized children

PNST
White M, Lawson K, Ramsey R, et al. Simple nutrition screening tool for pediatric inpatients. J Parenter Enter Nutr. 2015;40(3):392-398.

STRONGkids
Hulst JM, Zwart H, Hop WC, Joosten KM. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr.(1):106-111.

Pediatric Nutrition Risk Score (PNRS)
Sermet-Gaudelus I, Poisson-Salomon A, Colomb V, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr. 2000;72(1):64-70.

Screening Tool for the Assessment of Malnutrition in Pediatric Patients (STAMP)
McCarthy H, Dixon M, Crabtree I, Eaton-Evans M, McNulty H. The development and evaluation of the screening tool for the assessment of malnutrition in paediatrics (STAMP©) for use by healthcare staff. J Human Nutr Diet. 2012;25(4):311-318.

Pediatric Yorkhill Malnutrition score (PYMS)
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. Brit J Nutr. 2010;104(5):751-756.

PediSMART
Karagiozoglou-Lampoudi TD, E.; Lampoudis, D.; Apostolou, A.; Agakidis, C. Computer-Based Malnutrition Risk Calculation May Enhance the Ability to Identify Pediatric Patients at Malnutrition-Related Risk for Unfavorable Outcome. Journal of Parenteral and Enteral Nutrition 2015;39(4):418-25.

Pediatric Nutritional Screening Score (PNSS)
Lu L, Mao X, Sheng J, et al. Development and validation of a pediatric nutritional screening score (PNSS) for hospitalized children. Asia Pac J Clin Nutr 2018;27(1):65-71.

Overview of nutritional screening tools

• Three most cited pediatric nutritional screening tools in general population of hospitalized children: 

Pediatric Yorkhill Malnutrition Score (PYMS) (1)
Screening Tool for the Assessment for Malnutrition in Pediatrics (STAMP) (2)
Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONG_kids) (3)

• North American literature focused on the STRONGkids and Pediatric Nutrition Screening Tool (PNST) (4). 
   
• Similarities between tools:
  • Short questionnaires comprising 3-5 questions, with a score allocated to each step
  • Validation studies have compared the tools with current anthropometric measures (e.g., weight for height, weight for age or BMI), current nutritional status as assessed by a full dietetic assessment or the Subjective Global Nutritional Assessment (SGNA) (6) or risk of weight loss or need for nutritional intervention during the hospital stay
     
• Differences between the different tools:
  • Comparison of content criteria that a nutritional screening tool should encompass according to the European Society of Enteral and Parenteral Nutrition (ESPEN) (7) is given in the table below
  • Most tools require the acquisition and interpretation of anthropomotric measurements such as weight and heights, whilst this is not the case for the STRONG_kids (only a subjective assessment of the nutritional status is needed) or PNST (“is the child obviously underweight or overweight?”)
     
• Carter et al. preferred a modified version of the PNST in a Canadian study involving 165 hospitalized children (5) as it performed well at identifying children at high nutritional risk when compared to the reference standard of the Subjective Global Nutritional Assessment (SGNA) (6)
   
• No preference of one tool over another based on a large European study comparing the STAMP, PYMS and STRONG_kids (8) or in a systematic review that assessed the capability of PNRS, STAMP, PYMS and STRONG_kids to predict in-hospital weight loss, the clinical decision of a dietetic referral, the clinical decision of a nutritional intervention during hospitalization, a full dietetic assessment (9). 

Table 1: Aims, availability of validation studies, and components of available pediatric nutrition screening tools intended for mixed patient groups on admission to hospital

Click to expand

References 

1 Gerasimidis K, Macleod I, Maclean A, et al. Performance of the novel Paediatric Yorkhill Malnutrition Score (PYMS) in hospital practice. Clin Nutr 2011;30(4):430-5.

2 McCarthy HD, M.; Crabtree, I.; Eaton-Evans, M. J.; McNulty, H. The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP(c)) for use by healthcare staff. J Hum Nutr Diet 2012;25(4):311-8.

3 Hulst JM, Zwart H, Hop WC, et al. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr 2010;29(1):106-11.

4 White M, Lawson K, Ramsey R, et al. Simple Nutrition Screening Tool for Pediatric Inpatients. JPEN J Parenter Enteral Nutr 2016;40(3):392-8.

5 Carter LE, Shoyele G, Southon S, et al. Screening for Pediatric Malnutrition at Hospital Admission: Which Screening Tool Is Best? Nutr Clin Pract 2019.

6 Secker DJ, Jeejeebhoy KN Subjective global nutritional assessment for children. American Journal of Clinical Nutrition 2007;85(4):1083-89.

7 Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22(4):415-21.

8 Chourdakis M, Hecht C, Gerasimidis K, et al. Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population. Am J Clin Nutr 2016;103(5):1301-10.

9 Huysentruyt K, Devreker T, Dejonckheere J, et al. Accuracy of Nutritional Screening Tools in Assessing the Risk of Undernutrition in Hospitalized Children. J Pediatr Gastroenterol Nutr 2015;61(2):159-66.

10 Joosten KFH, J. M. Nutritional screening tools for hospitalized children: methodological considerations. Clin Nutr 2014;33(1):1-5.

11 Reilly HM, Martineau JK, Moran A, et al. Nutritional screening - evaluation and implementation of a simple nutrition risk score. Clinical Nutrition 1995;14(5):269-73.

12 Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr 2000;72(1):64-70.

13 Karagiozoglou-Lampoudi TD, E.; Lampoudis, D.; Apostolou, A.; Agakidis, C. Computer-Based Malnutrition Risk Calculation May Enhance the Ability to Identify Pediatric Patients at Malnutrition-Related Risk for Unfavorable Outcome. Journal of Parenteral and Enteral Nutrition 2015;39(4):418-25.

14 Lu L, Mao X, Sheng J, et al. Development and validation of a pediatric nutritional screening score (PNSS) for hospitalized children. Asia Pac J Clin Nutr 2018;27(1):65-71.