A simple nutrition screening tool to identify nutritional deterioration in long stay paediatric inpatients: the paediatric nutrition rescreening tool (PNRT)

Background and aims: Children with extended hospital stays are at risk of nutritional deterioration making regular nutrition screening throughout their admission an integral part of the nutrition care pathway. The purpose of this study was to design and validate a simple, quick and universal weekly rescreening tool to identify hospital acquired nutritional deterioration during a child's hospital stay. Methods: A prospective, longitudinal sample of children aged 0–16 years admitted to a paediatric tertiary hospital with a length of stay ≥7 days were included in the study. Agreement between nutritional deterioration markers of reduction in weight (kg), body mass index (kg/m), energy intake (kcal/day) and protein intake (g/day) over a 7-day period and two proposed rescreening questions was determined using sensitivity, specificity, area under the curve and positive and negative predictive values. Results: Sixty-one children were included in the study with 224 full 7-day datasets. The sensitivity and specificity of the rescreening question ‘Has the child had reduced nutritional intake in the last 7 days’ for identifying children with a ≥25% reduction in energy intake over the previous 7-day period were 61.9% (95% CI 41.1–82.7) and 82.2% (95% CI 76.9–87.5) respectively. The sensitivity of ‘Has the child lost weight or had poor weight gain’ at detecting weight loss was 71.4% (95% CI 54.7–88.2) and specificity 87.8% (95% CI 83.1–92.5). Conclusion: The paediatric nutrition rescreening questions provide a valid and simple tool to detect nutritional deterioration in long stay paediatric patients and should be an integral part of the nutrition care process