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Reproducibility and Inter-rater Reliability of 2 Paediatric Nutritional Screening Tools

Galera-Martínez, Rafael*,†; Moráis-López, Ana*,‡; Rivero de la Rosa, Maria del C.*,§; Escartín-Madurga, Laura||; López-Ruzafa, Encarnación*,†; Ros-Arnal, Ignacio*,¶; Ruiz-Bartolomé, Hector; Rodríguez-Martínez, Gerardo*,||; Lama-More, Rosa A.*,#

Journal of Pediatric Gastroenterology and Nutrition: March 2017 - Volume 64 - Issue 3 - p e65–e70
doi: 10.1097/MPG.0000000000001287
Original Article: Nutrition

Objectives: The aim of the present study was to assess reproducibility and inter-rater reliability of 2 nutritional screening tools (NST): Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) and Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP).

Methods: Prospective observational multicentre study. Patients ages 1 month or older admitted to paediatric or surgical wards were tested within 24 hours of admission by 2 independent observers: experts specialized in paediatric nutrition (physicians or dieticians) and clinical staff nonexpert in nutrition. Diagnosis on admission, underlying diseases, and length of stay were registered. Statistical analysis: Kappa index (κ) to evaluate agreement between observers.

Results: A total of 223 patients were included (53.4% boys), with mean age of 5.59 (95% confidence interval 4.94–6.22) years. Experts classified 9.9% of patients at high risk with STRONGkids and 19.7% using STAMP, whereas nonexpert staff assigned 6.7% of patients to the high-risk category with STRONGkids and 21.9% with STAMP. Agreement between expert and nonexpert staff was good: 94.78% for STRONGkids (κ 0.72 [P < 0.001]); 92.55% for STAMP (κ 0.74 [P < 0.001]). The rate of malnutrition was significantly higher among high-risk patients with both NST, independent of examiner experience. After adjusting for age, both STRONGkids and STAMP high-risk scores predicted longer length of stay, whether assessed by experts or nonexperts, although differences were higher with STRONGkids.

Conclusions: Agreement between experts and nonexpert staff in nutrition was good, producing a similar high-risk patient profile. Our results demonstrate that these NSTs are appropriate for nutritional screening in settings in which users have no previous experience in the field.

*On behalf of GETNI (Grupo Español de Trabajo en Nutrición Infantil)

Complejo Hospitalario Torrecárdenas, Almería

Hospital Universitario La Paz, Madrid

§Hospital Universitario Virgen Macarena, Sevilla

||IIS Aragón, Hospital Clínico Universitario Lozano Blesa Zaragoza

Hospital Infantil Universitario Miguel Servet, Zaragoza

#Centro Médico D-Medical, Madrid, Spain.

Address correspondence and reprint requests to Rafael Galera-Martínez, MD, PhD, Complejo Hospitalario Torrecárdenas, Camino de los Parrales 328, 1-4. CP 04720, Aguadulce, Almería, Spain (e-mail:

Received 19 March, 2016

Accepted 1 June, 2016

All procedures followed were in accordance with the ethical standards of the responsible Clinical Research Ethics Committee and with the WMA Declaration of Helsinki.

Informed consent was obtained from all patients (parents or legal guardians) for being included in the study.

The authors report no conflicts of interest.

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,