儿科住院患者简单营养筛查工具
编者按：本文提到的营养（不良）风险，并非欧洲肠外肠内营养学会营养风险筛查指南、中华医学会肠外肠内营养学分会临床诊疗指南推荐用于成人、以临床结局为观察指标的营养风险。
尽管流行病学调查表明住院儿童营养不良很常见，但在许多医院儿科营养筛查工具并未被常规应用。即使在成年人群中，现有工具也缺乏用于评定营养风险的简单性。
澳大利亚皇家儿童医院、玛特儿童医院、昆士兰科技大学、南博医院、格里菲斯大学发表研究报告，评估了为儿科住院患者设计、新型、快速、简单的儿科营养筛查工具（PNST）。
该研究根据儿科主观整体营养评定（SGNA）和人体测量，评估包括PNST在内的4个简单营养筛查问题的有效性。参与者为两家三级儿童医院和一家地区医院的儿科住院患者。
结果发现，对PNST问题的两项肯定回答可以最大化确定儿科SGNA和体重指数（BMI）z评分在评估295例患者营养不良过程中的特异性和敏感性。PNST发现37.6%的患者存在营养风险，而儿科SGNA为34.2%。PNST与儿科SGNA相比，敏感性和特异性分别为77.8%和82.1%。PNST对BMI的z评分＜-2患者的敏感性和特异性分别为89.3%和66.2%。PNST和儿科SGNA对发育不良或超重患者中的评估效果较差，敏感性和特异性均低于69%。
因此，除了现有的儿童营养筛查工具，例如儿科营养不良评定筛查工具（STAMP）、营养状态和生长发育风险筛查工具（STRONGkids）、儿科Yorkhill营养不良评分（PYMS），PNST提供了一个敏感、有效、较简单的选择，以确保住院儿童营养风险的早期发现。
JPEN J Parenter Enteral Nutr. 2016;40(3):392-8.
Simple Nutrition Screening Tool for Pediatric Inpatients.
White M, Lawson K, Ramsey R, Dennis N, Hutchinson Z, Soh XY, Matsuyama M, Doolan A, Todd A, Elliott A, Bell K, Littlewood R.
Royal Children's Hospital, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia; Mater Children's Hospital, South Brisbane, Queensland, Australia; Queensland University of Technology, Kelvin Grove, Queensland, Australia; Nambour Hospital, Nambour, Queensland, Australia; School of Public Health, Griffith University, Southport, Queensland, Australia; Mater Health Services, South Brisbane, Queensland, Australia; Mater Health Services and Griffith Health Institute, Griffith University, Queensland, Australia; Raymond Terrace, South Brisbane, Queensland, Australia.
BACKGROUND: Pediatric nutrition risk screening tools are not routinely implemented throughout many hospitals, despite prevalence studies demonstrating malnutrition is common in hospitalized children. Existing tools lack the simplicity of those used to assess nutrition risk in the adult population. This study reports the accuracy of a new, quick, and simple pediatric nutrition screening tool (PNST) designed to be used for pediatric inpatients.
MATERIALS AND METHODS: The pediatric Subjective Global Nutrition Assessment (SGNA) and anthropometric measures were used to develop and assess the validity of 4 simple nutrition screening questions comprising the PNST. Participants were pediatric inpatients in 2 tertiary pediatric hospitals and 1 regional hospital.
RESULTS: Two affirmative answers to the PNST questions were found to maximize the specificity and sensitivity to the pediatric SGNA and body mass index (BMI) z scores for malnutrition in 295 patients. The PNST identified 37.6% of patients as being at nutrition risk, whereas the pediatric SGNA identified 34.2%. The sensitivity and specificity of the PNST compared with the pediatric SGNA were 77.8% and 82.1%, respectively. The sensitivity of the PNST at detecting patients with a BMI z score of less than -2 was 89.3%, and the specificity was 66.2%. Both the PNST and pediatric SGNA were relatively poor at detecting patients who were stunted or overweight, with the sensitivity and specificity being less than 69%.
CONCLUSION: The PNST provides a sensitive, valid, and simpler alternative to existing pediatric nutrition screening tools such as Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), Screening Tool Risk on Nutritional status and Growth (STRONGkids), and Paediatric Yorkhill Malnutrition Score (PYMS) to ensure the early detection of hospitalized children at nutrition risk.
KEYWORDS: administration; life cycle; nutrition; nutrition assessment; nutrition support practice; pediatrics
PMID: 25096546
DOI: 10.1177/0148607114544321
