Elsevier

Clinical Nutrition

Volume 29, Issue 1, February 2010, Pages 106-111
Clinical Nutrition

Original Article
Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children

https://doi.org/10.1016/j.clnu.2009.07.006Get rights and content

Summary

Background & aims

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 STRONGkids, in a nationwide study.

Methods

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 STRONGkids 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.

Results

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 STRONGkids 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.

Conclusions

The nutritional risk screening tool STRONGkids 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.

Introduction

Children who are admitted to the hospital are at a high risk of developing malnutrition, especially children with an underlying disease.1, 2 High percentages of both acute and chronic malnutrition have been reported in different countries.1

In a tertiary hospital in France, Sermet-Gaudelus et al. (2000) found 62% of children had lost weight during their hospital stay.3 It is widely known that poor nutritional status has negative consequences for the child, underlining the importance to careful monitor. In two recent studies it was shown that both acute and chronic malnutrition affect the cognitive development of school-aged children.4, 5 Furthermore, poor weight gain in children with congenital heart defects, in the first months after surgery, was strongly related to later mortality.6

To prevent malnutrition, and especially hospital-acquired malnutrition along with its complications, early identification of nutritional depletion is essential, ideally on admission to the hospital. Such an approach provides the physician with the opportunity to apply appropriate nutritional interventions, in the hope of preventing complications. Currently, there is no consensus to the best method of assessing nutritional risk of children admitted to the hospital.

Three groups have attempted to develop such a nutritional risk screening tool for children. Sermet-Gaudelus et al.3 developed the ‘pediatric nutritional risk score’ and Secker and Jeejeebhoy7 the ‘subjective global nutritional assessment’ (SGNA) tool. Both these tools identify children at risk of malnutrition during hospitalization. However, we have found these tools to be complicated and time-consuming and consequently their uptake has been limited. Recently, McCarthy et al.8 developed the ‘STAMP’ tool, a combination of measurements of weight and height and two additional questions on disease risk and intake. We found this tool also complex to use and more of a nutritional assessment than a nutritional risk tool. There are no reports published using either of these scoring systems. We therefore attempted to develop an easy to apply nutritional risk screening tool, called STRONGkids, in an effort to overcome some of the issues with previous tools. Our tool consists of four areas (1) subjective global assessment (2) high risk disease (3) nutritional intake and losses (4) weight loss or poor weight increase. The aim of our study was to investigate the feasibility and value of this new nutritional risk screening tool on children admitted to hospitals in the Netherlands over three consecutive days.

Section snippets

Subjects

Every Dutch hospital (n = 101) containing a pediatric ward was invited to participate (by letter), on a voluntary basis. This included 93 general and 8 academic hospitals. Our three screening days took place from November 26th through November 28th 2007. Our inclusion criteria were, age>1 month, admission to a pediatric ward (intensive are patients excluded) and an expected stay of at least one day. The institutional review board of Erasmus Medical Centre approved the study protocol, and waived

Results

The overall hospital response rate was 52% (52 hospitals, 7 academic and 45 general). Of this four of the 45 general hospitals did not include any patients and 4 failed to return their case record forms. Finally 44 hospitals participated (7 academic and 37 general). A total of 424 children met the inclusion criteria (172 from the academic and 252 from the general hospitals). Baseline characteristics are shown in Table 2. The median age was 3.5 years (range 31 days–17.7 years) and the median

Discussion

This is the first study in which a nutritional risk screening tool, called STRONGkids, was used in a nationwide setting. The STRONGkids tool is a comprehensive summary of commonly asked questions concerning nutritional issues, combined with a clinical view of the child's status. It is performed on admission to the hospital and it will help to raise the clinician's awareness of nutritional risks. In this study almost half of all Dutch hospitals (both academic and general) participated and the

Conflict of interest

No conflicts of Interests declared by all authors.

Statement of authorship

JH and KJ proposed the study, and participated in its design and coordination as well as drafted the manuscript. HZ carried out the studies and helped to analyze the data and helped to draft the manuscript. WH performed the statistical analysis and interpretation of data together with JH and helped to draft the manuscript. All authors read and approved the final manuscript.

Acknowledgements

Our thanks goes to all the participating children and their parents for their cooperation, as well to all the participating hospitals, their contact persons and the nursing and medical staff for performing the measurements and questionnaire and to the seven students who were prepared to go to all academic hospitals to assist the coordinating physicians and collect the forms. We also thank Nutricia Nederland BV (Zoetermeer, the Netherlands) for their financial support. Nutricia played no role in

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Conference presentation: Conference of Dutch Society of Pediatrics, Veldhoven, The Netherlands, November 6th 2008.

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