EVALUATION OF THE SCREENING TOOL FOR THE ASSESSMENT OF MALNUTRITION IN PEDIATRICS (STAMP) AMONG HOSPITALIZED CHILDREN IN A PRIVATE TERTIARY HOSPITAL IN METRO MANILA

Authors: Racquel C. Andaya, MD, Divina Cristy D. Redondo-Samin, MD; Grace C. Paguia, MD

Publisher: Clinical Nutrition ESPEN an international journal devoted to clinical nutrition and metabolism

Publication Date: DECEMBER, 2021

URL: https://doi.org/10.1016/j.clnesp.2021.09.517

ABSTRACT:
Objective: This study aimed to evaluate the use of the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) 1 for identifying malnutrition among hospitalized children in a private tertiary hospital in Metro, Manila.
Background: Early detection of malnutrition risk in hospitalized children is of high clinical importance, hence, the need for a validated pediatric nutrition screening tool. STAMP is a quick, easy to use tool, requiring no nutritional expertise and minimal training to implement but needs to be evaluated and validated in the Philippine setting.
Methods: Design and Setting: This is a cross-sectional study done in St. Luke’s Medical Center Quezon City and Global City Participants: A total of 163 children, aged 1 month to 18 years old, admitted in non-critical and non-COVID-19 units from January to March 2021 were included in the study.
Intervention: All admitted children had routine nutrition screening done by the nurses upon admission. Risks were assigned based on BMI Z scores (z score -2, between +1 and +2 and above +2 means “at risk”; z score between +1 and -1 means “not at risk). Eligible children then underwent a second screening using STAMP performed by either the trained dietitian or nutrition physician. Overall risks were determined based on the following STAMP scores: 4 high, 2-3 medium and 0-1 low. To verify screening results, all children screened through STAMP had full nutritional assessment completed by the same assessor to determine nutritional status.
Main Outcome Measures: Malnutrition risk identified by STAMP and as confirmed by full nutritional assessment. Means and standard deviation were computed for continuous variables while numbers and percentages were used for categorical variables. Diagnostic values (sensitivity, specificity, PPV, NPV, odds ratio) were likewise computed for STAMP.
Results: The estimated prevalence of malnutrition in this population is 81% based on full nutritional assessment, 46% (n=75) using BMI Z scores and 92% (n=150) using STAMP. Of the 150 found nutritionally at risk, 49 children (36%) were classified as medium risk (STAMP score 2-3) while 101 (67%) were high risk of malnutrition (STAMP score 4). STAMP had a sensitivity and specificity of 97.7% and 32.3%, respectively. The positive predictive value indicated that 86% of the children who were classified as being at risk of malnutrition were truly malnourished as confirmed by full nutritional assessment. STAMP demonstrated fair reliability with = 0.3855 (p< 0.0001).
Conclusion: The evaluation of STAMP presents acceptable diagnostic values for identification of malnutrition risk among hospitalized pediatric patients in a private tertiary hospital in Metro Manila. It is a feasible screening tool for malnutrition among hospitalized pediatric patients. Further studies are recommended to validate and determine reproducibility of STAMP in other acute hospital settings and specific pediatric population. Future studies need to concentrate on improving nutrition screening and assessment and integrate them in routine patient care.