- 期刊
- Ahead-of-Print
Development and validation of a pediatric nutritional screening score (PNSS) for hospitalized children
摘要
Background and Objectives: Undernutrition is common in hospitalized children. However, there is no evidence on the most effective nutritional screening tool. The objective of this study was to develop and validate a pediatric nutritional screening tool with a simple and quick scoring system to assess undernutrition risk upon hospital admission. Methods and Study Design: The study had a two-phase prospective observational design. A novel pediatric nutritional screening score (PNSS) was developed. The optimal cut-off value of PNSS was determined by receiver operating characteristic curves used to classify patients according to whether they were 'at-risk of undernutrition' or 'not at-risk', based on PNSS and body composition data. In the evaluation phase, PNSS sensitivity, specificity, and reliability were evaluated by comparing the data with a complete dietetic assessment. Additionally, other nutritional screening tools (PYMS, STAMP, and STRONG_(kids)) were used in the comparisons. Length of hospital stay, weight loss, disease complications, and nutritional support during hospitalization were recorded. Results: PNSS consisted of three elements: disease with malnutrition risks, changes in food intake, and anthropometric measurements, with a score of 0-2 for each element. The optimal cut-off score to identify patients (n=96) at risk of undernutrition was 2. The percentage of children with undernutrition risk was 44.9%. Children with oncologic, gastrointestinal, and cardiac diseases were most likely to be at risk of undernutrition. The agreement between PNSS and the complete dietetic assessment was moderate (κ=0.435, 95% CI=0.373-0.498). Sensitivity and specificity values of PNSS were 82% (95% CI=76%-87%) and 71% (95% CI=67%-74%), respectively. Inter-rater agreement had a κ value of 0.596 (95% CI=0.529-0.664, p＜0.001). Compared with the dietetic assessment, PYMS had high specificity (95.4%) and low sensitivity (49.0%) and STRONGkids had high sensitivity (83.2%) and low specificity (60.2%). STAMP and PYMS had moderate agreement with the dietetic assessment (κ=0.479, 0.506), and STRONGkids had a fair agreement (κ=0.304). The at-risk group was associated with significantly longer length of hospital stay and higher percentage of weight loss compared with the not-at-risk group. Conclusion: PNSS is the first pediatric nutritional screening tool developed for hospitalized children and validated in a large population of patients in China. PNSS is a simple and reliable tool for the detection of undernutrition risk upon hospital admission.
延伸閱讀
- Aruğaslan, E., Zengin, A., Karatas, M. B., & Akyüz, S. (2022). Prognostic Significance of Controlling Nutritional Status Score (CONUT) in Patients Undergoing Pericardiocentesis. Acta Cardiologica Sinica, 38(1), 84-90. https://doi.org/10.6515/ACS.202201_38(1).20210718A
- 黃立琪、孫世恆、李若樺、張鳳媛、鄭睿芬、陳麗麗（2011）。Pediatric Nurses: Cognition of Young Child Development and Attitudes and Behaviors toward Developmental Care。護理雜誌，58(3)，53-63。https://doi.org/10.6224/JN.58.3.53
- 楊淑惠、陳偉德、張瑞玲、鄭安平、黃惠娟、杭極敏、陳德全（1988）。The Assessment of the Nutritional Status of the Hospitalized Patients。中華民國營養學會雜誌，13(3&4)，75-84。https://doi.org/10.6691/JCNS.198810_13(3_4).0002
- M.Fomina, Borovik, T., Gusev, A., Yatsyk, S., Zvonkova, N., L.Lebedeva, Shi, Z., & Jiao, F. (2013). Pediatric perioperative nutritional assessment and support. Asia Pacific Journal of Clinical Nutrition, (), 1-41. https://doi.org/10.6133/apjcn.202211/PP.0002
- Tung, Y. C., Ni, Y. H., Lai, H. S., Hsieh, D. Y., & Chang, M. H. (2006). Clinical Improvement Following Home Parenteral Nutrition in Pediatric Patients with Intestinal Failure. Journal of the Formosan Medical Association, 105(5), 399-403. https://doi.org/10.29828/JFMA.200605.0006