儿童营养评估量表使用

STAMP评估量表儿童营养评估及筛查住院患者：住院患者营养风险筛查的理由决定选用哪种筛选工具能准确评估营养决定选用哪种营养筛查工具适用于住院儿科病人院内实施营养筛查的程序管理具有营养风险患者营养风险评估目的营养风险评估目的：指导临床患儿营养计划制定提高营养意识，促进营养实践预测患儿住院时长预测患儿住院期间体重的降低及营养支持的需求识别存在营养失调及喂养困难的患儿营养评估工具要求太复杂太耗时太专业敏感性、特异性、有效性和可靠性简单、容易实施，不需要额外培训快速、费用低、无创普遍性，使用所有患者筛选病人营养不良的风险,需要营养评估来确定患者需要干预理想评估工具儿童营养风险评估工具STRONGkidsNutritionalriskscreeningtool(Hulst,2010)PaediatricYorkhillMalnutritionScore(PYMS)(Gerasimidis,2010)ScreeningToolforAssessmentofMalnutritioninPaediatrics(STAMP)(McCarthy,2012)PaediatricNutritionScreeningTool(PNST)(White,2014)SubjectiveGlobalNutritionalAssessment(SGNA),(SeekerandJeejeebhoy,2007)STRONGKIDSHulstetal2010,N=424,3-18yearsHadthehighestnumberofsecondaryvalidationstudies(Huysentruytetal,2016;Spagnuoloetal,2013;Wonoputrietal,2014)SecondaryValidationshowedhighsensitivity(81%),moderatespecificity(37%)Goodagreementbetweennursesandpaediatricians(Moeenietal,2014)MostnursesfoundthetooleasytounderstandTakes1-5minutestocomplete7/15nursesfoundthetoolhardertocompleteduringbusyshifts.STRONGKIDSSubjectiveClinicalAssessment:diminishedsubcutaneousmusclemassand/orhollowfaceHighRiskWeightlossorpoorweightgain?weightlossornoweightgain(infants<1year)duringthelastfewweeks/months?NutritionalintakeandlossesExcessivediarrhoea≥5perdayand/orvomiting(>3timesperday)thelastfewdays?Reducedfoodintakeduringthelastfewdaysbeforeadmission?Pre-existingdieteticallyadvisednutritionalintervention?Inabilitytoconsumeadequateintakebecauseofpain?0pointslowrisk,1-3pointsmediumrisk,4ormorepointshighriskPYMSForchildren1-16yearsN=247.ValidatedbyNursescreeningcomparedtofullpaediatricSGNAbyadietitian.Sensitivity85%Specificity87%InformationandusersguidePYMSbodymassindexcalculatorNursequickreferenceguidetoPYMSPYMSSTAMPMedicalandSurgicalinpatients2-17yearsDevelopment(n=122)viastructuredquestionnaireVsfulldieteticnutritionassessmentValidation(n=238)fulldieteticnutritionassessmentvsSTAMPSecondaryvalidation82%sensitivityand54%specificity(McCarthyetal,2012;LarnaMoreetal,2012;Wonoputrietal,2014)STAMPSTAMPSTAMPSTAMP—案例患者，女，11月，7.2kg，因“发现全身黄染，腹泻十余天，发热一天”于7.29入院，入院诊断脓毒症？黄疸查因、腹泻病首次护理记录：患儿食欲降低，小便正常，大便：4-5次黄烂便STAMP评分？？？入院后患儿口服配方奶，100→120mlQ4h7.31

目前诊断：先天性胆管扩张、脓毒症、腹泻病，→禁食水、胃肠减压STAMP评分？？？STRONGKIDS、PYMS，STAMPChourdakisetalAmJClinNutr2016;103:1301-102567patients,14hospitals,12EuropeancountriesModerateagreementofhighnutritionriskbetweentools(STRONGkids10%highriskvsPYMS25%)ChildrenidentifiedathighnutritionriskhadlongerLOSandlowerMUACandTricepSkinfolds.19%-23%ofchildrenidentifiedasatriskhadaBMIzscore≤2Couldnotconcludethat‘onetoolsuperiorovertheother’STRONGKIDS、PYMS，STAMPChourdakisetalAmJClinNutr2016;103:1301-102567patients,14hospitals,12EuropeancountriesModerateagreementofhighnutritionriskbetweentools(STRONGkids10%highriskvsPYMS25%)ChildrenidentifiedathighnutritionriskhadlongerLOSandlowerMUACandTricepSkinfolds.19%-23%ofchildrenidentifiedasatriskhadaBMIzscore≤2Couldnotconcludethat‘onetoolsuperiorovertheother’PNSTPerformedaspartofaroutineadmissionprocessbyNursesSimpleQuickTakeslimitedprintingspaceAvoidsanthropometricmeasuresandreferencetostandardsAppliestoallinpatientsandagesCheapValidPNSTPNSTPNSTidentified37.6%ofpatientsasatnutritionalriskPaediatricSGNAidentified34.2%ofpatientsasatnutritionalrisk.9.8%ofpatientshadaBMIzscoreof≤-230%ofchildrenhadunintentionallylost