StrongKids for pediatric nutritional risk screening in Brazil: a validation study

Objectives To evaluate the validity and reproducibility of StrongKids as a pediatric nutritional screening tool in Brazil, which has no validated method for this purpose. Methods A cross-sectional study was conducted with 641 patients admitted to the pediatric care unit of a public hospital from 2014 to 2018. The concurrent validity was assessed by evaluating the sensitivity, specificity, and the positive and negative predictive values of StrongKids in detecting acute, chronic, and overall malnutrition. Predictive validity was determined by calculating the same indices to identify longer than median hospital stay, need of enteral nutrition, 30-day hospital readmission, transfer to hospitals with more complex procedures, and death. StrongKids was reapplied to a subsample to evaluate the inter-rater reproducibility. Results Prevalence of low risk was 15.6%, moderate risk was 63.7%, and high nutritional risk was 20.7%. A positive test, corresponding to the moderate or high risk category, identified all those with acute malnutrition and showed sensitivity of 89.4% (95% CI: 76.9-96.4) and 94.0% (95% CI: 86.6-98.0) for the detection of chronic and overall malnutrition, respectively. Regarding its predictive capacity, 100% of the patients who needed enteral nutrition, who were transferred, died, or were readmitted to hospital within 30 days after discharge were considered in risk by StrongKids, and the sensitivity to identify those with prolonged hospital stays was 89.2 (95% CI: 84.6-92.7). The inter-rater agreement was excellent (PABAK: 0.87). Conclusions StrongKids had satisfactory validity and reproducibility and successfully identified nutritional deficits and predict unfavorable health outcomes. Our results support the use of StrongKids as a pediatric nutritional risk screening method in Brazil.