Study On The Value Of The Two Nutritional Risk Screening Tools In Hospitalized Children

Objective:To investigate the nutritional risk in tertiary hospitalized pediatric patients,and to evaluate the values of the Screening Tool for Risk of Impaired Nutritional Status and Growth(STRONGkids)and the Adductor pollicis muscle thickness(APMT)in hospitalized pediatric patients.To identify their applicability and effectiveness,providing the evidences for clinical workers to improve nutritional care in the pediatric hospital setting.Methods:Pediatric patients hospitalized in the department of pediatric medicine of a tertiary hospital from May 1,to September 1,2019 were enrolled in our study.At the time of admission,STRONGkids and APMT were used simultaneously to screen the children’s nutritional status,and the nutritional screening tools’ results were analyzed.Z value evaluation method were served as the golden standard,to evaluate the tools’ sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),the receiver operating characteristic curve(ROC)’s area under the curve(AUC)and concurrent(consistent with the different screening tool for screening results).Results:1.A total of 483 hospitalized pediatric patients were included in the study.According to the STRONGkids tool’s results: of the 483 hospitalized pediatric patients,254(52.6%)were at low nutritional risk,222(46.0%)were at moderate nutritional risk,and 7(1.4%)were at high nutritional risk;the top three diseases at high nutritional risk were diseases of the digestive system,urinary system and immune system.According to the APMT tool results: of the 483 hospitalized pediatric patients,368(76.2%)were without nutritional risk,while 115(23.8%)were with nutritional risk;the younger the hospitalized child,the higher the incidence of nutritional risk;the top three nutritional risk diseases were immune system disease,urinary system disease and digestive system disease.2.STRONGkids were evaluated with z-score as the golden standard.When STRONGkids scored 2,the area under ROC was 0.731,the sensitivity was 0.611,and the specificity was 0.851,the PPV was 34.0%,and the NPV was 94.6%.The concurrent test between STRONGkids and z-score was statistically significant(P=0.000),and the coefficient of Kappa(κ)was 0.343.3.APMT were evaluated with z-score as the golden standard,the results showed that:(1)the best cut-off value of ROC in male pediatric patients aged equal to and more than 6 years old was 7.1,the area under curve(AUC)of ROC was 0.928(95%CI:0.883-0.972),the sensitivity was 0.883,the specificity was 1.000,the PPV was23.8%,the NPV was 100.0%,and the concurrent result was: κ = 0.348,P = 0.001;(2)the best cut-off value of ROC in female pediatric patients aged equal to and more than 6years old was 7.9,the AUC of ROC was 0.905(95%CI: 0.836-0.974),the sensitivity was 0.810,the specificity was 0.929,the PPV was 44.8%,the NPV was 98.6%,and theκ =0.510,P=0.000;(3)the best cut-off value of ROC in male pediatric patients aged less than 6 years old was 6.3,the AUC of ROC was 0.799(95%CI: 0.682-0.915),the sensitivity was 0.790,the specificity was 0.833,the PPV was 28.6%,the NPV was97.9%,and the κ =0.335,P=0.000;(4)the best cut-off value of ROC in female pediatric patients aged less than 6 years old was 6.5,the AUC of ROC was 0.816(95%CI:0.720-0.911),the sensitivity was 0.831,the specificity was 0.652,the PPV was 50.0%,the NPV was 90.2%,and the κ=0.435,P=0.000.4.Using z-score as the golden standard,STRONGkids and APMT were compared simultaneously.The results showed that the AUC of ROC in STRONGkids was 0.731(95%CI: 0.651-0.811),while APMT was 0.814(95%CI: 0.749-0.880).The concurrent test in these two screening tools was statistically significant(P=0.035),and the κ was0.095.Conclusion:1.The incidence of nutritional risk of tertiary hospitalized pediatric patients was still at a high level,and the younger the age,the higher the incidence of nutritional risk.It was of great importance to routinely screen the nutritional risk of hospitalized pediatric patients.2.The APMT,as a simple,economical and reliable screening tool,has higher sensitivity and lower professional dependence than STRONGkids.The APMT is an efficient parameter for the detection of malnutrition in hospitalized pediatric patients.