StrongKids for pediatric nutritional risk screening in Brazil: a validation study

Children admitted to the hospital are at risk of developing malnutrition. The aim of the present study was to investigate the feasibility and value of a new nutritional risk screening tool, called STRONG(kids), in a nationwide study. A Prospective observational multi-centre study was performed in 44 Dutch hospitals (7 academic and 37 general), over three consecutive days during the month of November 2007. The STRONG(kids) screening tool consisted of 4 items: (1) subjective clinical assessment, (2) high risk disease, (3) nutritional intake, (4) weight loss. Measurements of weight and length were performed. SD-scores <-2 for weight-for-height and height-for-age were considered to indicate acute and chronic malnutrition respectively. A total of 424 children were included. Median age was 3.5 years and median hospital stay was 2 days. Sixty-two percent of the children were classified "at risk" of developing malnutrition by the STRONG(kids) tool. Children at risk had significantly lower SD-scores for weight-for-height, a higher prevalence of acute malnutrition and a longer hospital stay compared to children with no nutritional risk. The nutritional risk screening tool STRONG(kids) was successfully applied to 98% of the children. Using this tool, a significant relationship was found between having a "high risk" score, a negative SD-score in weight-for-height and a prolonged hospital stay. Copyright 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Hospital protein-energy malnutrition and its adverse consequences were already described back in 1980. The purpose of this review is to describe the current prevalence of malnutrition in hospitalized children and to describe current risk groups. Different definitions have been used to describe malnutrition. According to WHO criteria, the SD score with a cutoff of less than -2 should be used to define malnutrition and to compare prevalence data. Using the SD score for weight for height or equivalent criteria, the prevalence of acute malnutrition over the last 10 years in hospitalized children in Germany, France, the UK and the USA varied between 6.1 and 14%, whereas in Turkey up to 32% of patients with malnutrition were reported. Acute malnutrition is still highly prevalent in children with an underlying disease; however, the prevalence rate seems lower in children with cystic fibrosis and malignancies. The prevalence of acute malnutrition of children admitted to hospital is still considerably high, but there is a scarcity of data concerning the nutritional status during hospital admission. Screening tools to identify children at risk of developing malnutrition might be helpful.

In response to questions about tools for nutrition screening, an evidence analysis project was developed to identify the most valid and reliable nutrition screening tools for use in acute care and hospital-based ambulatory care settings. An oversight group defined nutrition screening and literature search criteria. A trained analyst conducted structured searches of the literature for studies of nutrition screening tools according to predetermined criteria. Eleven nutrition screening tools designed to detect undernutrition in patients in acute care and hospital-based ambulatory care were identified. Trained analysts evaluated articles for quality using criteria specified by the American Dietetic Association's Evidence Analysis Library. Members of the oversight group assigned quality grades to the tools based on the quality of the supporting evidence, including reliability and validity data. One tool, the NRS-2002, received a grade I, and 4 tools-the Simple Two-Part Tool, the Mini-Nutritional Assessment-Short Form (MNA-SF), the Malnutrition Screening Tool (MST), and Malnutrition Universal Screening Tool (MUST)-received a grade II. The MST was the only tool shown to be both valid and reliable for identifying undernutrition in the settings studied. Thus, validated nutrition screening tools that are simple and easy to use are available for application in acute care and hospital-based ambulatory care settings.