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Implementation of an Automated Pediatric Malnutrition Screen Using Anthropometric Measurements in the Electronic Health Record

Published:October 05, 2018DOI:https://doi.org/10.1016/j.jand.2018.07.014
      Nutrition evaluation and intervention in hospitalized pediatric patients is critical, because undernutrition negatively impacts physical and cognitive development, wound healing, immune function, mortality, and quality of life.
      • Brinksma A.
      • Sanderman R.
      • Roodbol P.F.
      • et al.
      Malnutrition is associated with worse health-related quality of life in children with cancer.
      • Co-Reyes E.
      • Li R.
      • Huh W.
      • Chandra J.
      Malnutrition and obesity in pediatric oncology patients: Causes, consequences, and interventions.
      • Lange B.J.
      • Gerbing R.B.
      • Feusner J.
      • et al.
      Mortality in overweight and underweight children with acute myeloid leukemia.
      • Mehta N.M.
      • Corkins M.R.
      • Lyman B.
      • et al.
      Defining pediatric malnutrition: A paradigm shift toward etiology-related definitions.
      Multiple, validated pediatric nutrition screening tools are available, yet no consensus on the ideal tool exists.
      • Chourdakis M.
      • Hecht C.
      • Gerasimidis K.
      • et al.
      Malnutrition risk in hospitalized children: Use of 3 screening tools in a large European population.
      • Elia M.
      • Stratton R.J.
      Considerations for screening tool selection and role of predictive and concurrent validity.
      • Gerasimidis K.
      • Keane O.
      • Macleod I.
      • Flynn D.M.
      • Wright C.M.
      A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital.
      • Joosten K.F.
      • Hulst J.M.
      Nutritional screening tools for hospitalized children: Methodological considerations.
      • McCarthy H.
      • Dixon M.
      • Crabtree I.
      • Eaton-Evans M.J.
      • McNulty H.
      The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP(c)) for use by healthcare staff.
      Generally, the aims of the nutrition screening process are identification of current nutrition status and determination of a need for further nutrition assessment and intervention.
      • Joosten K.F.
      • Hulst J.M.
      Nutritional screening tools for hospitalized children: Methodological considerations.
      • Hartman C.
      • Shamir R.
      • Hecht C.
      • Koletzko B.
      Malnutrition screening tools for hospitalized children.
      Nutrition screening tools include, but are not limited to, dietary intake, anthropometrics, comorbid disease state, and subjective assessment of body habitus.
      • Joosten K.F.
      • Hulst J.M.
      Nutritional screening tools for hospitalized children: Methodological considerations.
      • Hartman C.
      • Shamir R.
      • Hecht C.
      • Koletzko B.
      Malnutrition screening tools for hospitalized children.
      These manual screening tools require variable time commitments for completion by nurses, physicians, or dietitians.
      • Joosten K.F.
      • Hulst J.M.
      Nutritional screening tools for hospitalized children: Methodological considerations.
      • Hartman C.
      • Shamir R.
      • Hecht C.
      • Koletzko B.
      Malnutrition screening tools for hospitalized children.
      In addition, nutrition screens are typically completed once on admission and do not continue repeatedly throughout an admission. Likewise, most traditional screens are not applicable when patients cross care environments such as transitioning from the inpatient to an outpatient setting. Although the general consensus is that nutrition screening is important, no universal, standardized approach exists for pediatric inpatients.
      • Hartman C.
      • Shamir R.
      • Hecht C.
      • Koletzko B.
      Malnutrition screening tools for hospitalized children.
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