Performance of different nutrition risk screening tools in predicting malnutrition in critically ill children on mechanical ventilation: A comparison study

Abstract

Background: This study aimed to characterize the distribution of nutrition status and nutrition risk stratification in critically ill children undergoing mechanical ventilation and to evaluate the association of nutrition risk with their clinical outcomes. Methods: This comparison study included 375 critically ill children receiving mechanical ventilation (invasive or noninvasive, duration ≥24 h). Nutrition status at admission was evaluated using body mass index z score, and nutrition risk was assessed via three validated tools: Paediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk on Nutritional Status and Growth (STRONGkids). Clinical data were extracted from electronic records. Results: Three hundred seventy-five critically ill children undergoing mechanical ventilation were enrolled (207 boys, 168 girls; median age, 8 [2–26.5] months), with 246 receiving invasive and 129 noninvasive ventilation; 20.6% had moderate-severe malnutrition (59.7% in invasive ventilation). All tools identified >60% at high risk. STRONGkids (area under the curve [AUC], 0.90) and PYMS (AUC, 0.86) better predicted malnutrition than STAMP (AUC, 0.74). STRONGkids (AUC, 0.89) outperformed in mortality prediction. Higher risk correlated with longer ventilation/pediatric intensive care unit stay, higher costs, and worse outcomes (P < 0.05). Multivariate analysis showed malnutrition, clinical diagnosis, and lactate level as independent risk factors and no organ dysfunction, healthy serum prealbumin level, and healthy serum albumin level as protective factors. Conclusion: PYMS and STRONGkids demonstrated high predictive value for moderate-to-severe malnutrition and mortality in children undergoing mechanical ventilation.