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Comparison of the paediatric Yorkhill malnutrition score (PYMS) with other paediatric screening/assessment methods

Published online by Cambridge University Press:  01 April 2010

K. Gerasimidis ,
O. Keane ,
I. Macleod ,
E. Buchanan ,
P. Mcgrogan ,
G Stewart ,
A. Maclean ,
D. F. Flynn  and
C. M. Wright
O. Keane
Affiliation:
Women and Children Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK
I. Macleod
Affiliation:
Women and Children Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK
E. Buchanan
Affiliation:
Women and Children Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK
P. Mcgrogan
Affiliation:
Women and Children Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK
G Stewart
Affiliation:
Women and Children Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK
A. Maclean
Affiliation:
Women and Children Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK
D. F. Flynn
Affiliation:
Women and Children Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK
C. M. Wright
Affiliation:
Faculty of Medicine, University of Glasgow, Glasgow,UK
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Abstract

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Information
Proceedings of the Nutrition Society , Volume 69 , Issue OCE2: Malnutrition Matters, Joint BAPEN and Nutrition Society Meeting, 13–14 October 2009, Cardiff , 2010 , E217
Copyright
Copyright © The Authors 2009

All inpatients should be screened for malnutrition(1) but validated paediatric tools for use by nursing staff are scarce. The Paediatric Yorkhill Malnutrition score (PYMS) was developed based on ESPEN guidelines(Reference Kondrup, Allison and Elia2). Its development, performance(Reference Gerasimidis, Macleod and McGrogan3), criterion validity, inter-rater reliability(Reference Gerasimidis, Keane and Macleod4) and impact on clinical practice(Reference Macleod, Gerasimidis and Purcell5) have been assessed. This study compared the PYMS with other similar paediatric tools.

Two research dietitians screened malnutrition using the PYMS, the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP)(Reference McCarthy, McNulty and Dixon6) and the paediatric Subjective Global Nutritional Assessment (SGNA)(Reference Secker and Jeejeebhoy7) in inpatients (1–16 years) from a tertiary paediatric (n=225) and district general hospital (n=22).

Two hundred and forty seven children consented to the study. The prevalence of malnutrition varied between the different tools. Compared to PYMS, STAMP identified more patients as being at risk, while SGNA identified fewer (Table 1).

Table 1

Eighty percent (198/247) of the patients were classified at the same risk of malnutrition between STAMP and PYMS and 81% (199/247) between SGNA and PYMS (Table 2). The agreement between STAMP and PYMS was moderate (κ=0.47 95% CI [0.34–0.61]) and between SGNA and PYMS slight (κ=0.12 95% CI [–0.11–0.34]). PYMS identified all the children who screened at risk by SGNA but only 52% of those screened at risk by STAMP (Table 2). Likewise 20% and 9% of the patients screened at low risk using SGNA and STAMP were classified at risk by PYMS (Table 2).

Table 2

*Low and medium risk combined.

STAMP identified a greater percentage of inpatients as being at medium or high risk, while PYMS identified a more manageable proportion. PYMS agreed poorly with SGNA which identifies malnourished rather than patients at risk of developing malnutrition. Comparison against dietetic assessment is needed to explore which screening tool has better diagnostic validity.

References

1. NHS Quality Improvement Scotland (2003) Food, Fluid and Nutritional Care in Hospitals.Google Scholar
2. Kondrup, J, Allison, SP, Elia, M et al. (2003) Clin Nutr 22, 415–421.CrossRefGoogle Scholar
3. Gerasimidis, K, Macleod, I, McGrogan, P et al. . (2009a) BSPGHAN Annual Winter Meeting 2009Google Scholar
4. Gerasimidis, K, Keane, O, Macleod, I et al. . (2009b) ESPGHAN Annual Meeting 2009 (in press).Google Scholar
5. Macleod, I, Gerasimidis, K, Purcell, O et al. . (2009) ESPGHAN Annual Meeting 2009 (in press)Google Scholar
6. McCarthy, H, McNulty, H, Dixon, M et al. (2008) JHum Nutr Diet 21, 395–396.CrossRefGoogle Scholar
7. Secker, DJ & Jeejeebhoy, KN (2007) Am J Clin Nutr 85, 1083–1089.CrossRefGoogle Scholar
Figure 0

Table 1

Figure 1

Table 2