10.1016/s0029-7437(05)70515-2

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<h4>Aim</h4>The low sensitivity of STRONGkids, a nutrition risk screening tool, was observed during its implementation in patient care services at a tertiary care hospital. The screening process improvement was performed to enhance its effectiveness. This study aimed to evaluate the validity and inter-rater reliability of the screening tool after the improvement process.<h4>Methods</h4>This was a cross-sectional study that collected baseline characteristics and clinical data from medical records. STRONGkids score and risk classification were recorded by ward nurses. Concurrent validity was assessed with respect to nutritional status, including undernutrition (BMI Z-score < -2), stunting (height-for-age Z-score < -2), and overall malnutrition (including both undernutrition and stunting). Nutrition risk screening was repeated by a nutrition nurse to determine inter-rater reliability.<h4>Results</h4>The study enrolled 1419 paediatric admissions. Undernutrition, stunting, and overall malnutrition were observed in 13%, 17%, and 27.6% of participants, respectively. STRONGkids classified 24%, 71.1%, and 4.9% of patients as having low, moderate, and high nutrition risk, respectively. Patients with high nutrition risk had significantly longer hospital stays and higher rates of hospital-acquired infections. STRONGkids demonstrated sensitivities of 82.4%-82.6% and specificities of 25%-26.5% for nutrition status. Inter-rater reliability was assessed across 320 admissions and showed excellent reliability for both the total score (k = 0.84; p < 0.001) and risk categories (k = 0.89; p < 0.001).<h4>Conclusion</h4>The performance of the nutrition risk screening tool may differ from that observed in research settings when used in routine clinical practice. STRONGkids demonstrates satisfactory validity and inter-rater reliability after the improvement process.

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