Diagnostic Performance of the StrongKids Tool for Identifying Hospital-Acquired Malnutrition in Pediatric Inpatients
DOI:
https://doi.org/10.6000/1929-4247.2026.15.04.6Keywords:
Pediatric malnutrition, hospital-acquired malnutrition, STRONGkids, nutritional screening, diagnostic accuracy, ROC analysis, weight loss, pediatric inpatientsAbstract
Background: Hospital-acquired malnutrition is a critical yet often underrecognized condition in pediatric inpatients and is associated with adverse clinical outcomes, including prolonged hospitalization and increased morbidity. Reliable screening tools such as STRONGkids are essential to facilitate early identification, but their diagnostic performance may vary across settings.
Methods: This diagnostic accuracy study with prospective in-hospital follow-up was conducted among pediatric inpatients aged 1 month to 18 years in Wangaya Regional General Hospital, Denpasar, from September to November 2025. STRONGkids screening was performed within 24 hours of admission. Hospital-acquired malnutrition was determined based on percentage body weight loss measured at admission and discharge. Diagnostic performance was assessed using sensitivity, specificity, predictive values, likelihood ratios, and ROC curve analysis, with optimal cut-off determined by the Youden Index.
Results: Among 92 pediatric inpatients, hospital-acquired malnutrition occurred in 34.7%. No significant associations were observed between malnutrition and sex, age, baseline nutritional status, diagnosis, disease category, or length of hospital stay (all p > 0.05), although baseline nutritional status showed a near-significant trend (p = 0.072). Receiver operating characteristic analysis demonstrated moderate discriminative ability of STRONGkids (AUC = 0.676). A cut-off score of ≥1 yielded the highest Youden Index (0.558), with a sensitivity of 87.5%, specificity of 68.3%, positive predictive value of 59.6%, and negative predictive value of 91.1%.
Conclusion: STRONGkids is a valuable screening tool for early detection of hospital-acquired malnutrition in pediatric inpatients, supporting routine universal nutritional screening.
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