Screening tool risk on nutritional status and growth

Abstract

The Screening tool risk on nutritional status and growth, widely known as STRONG Kids, is a concise and effective Screening tool designed for the early detection of existing Malnutrition or the risk of developing it in pediatric patients. This instrument utilizes a standardized set of four key questions to rapidly assess a child’s nutritional vulnerability. The STRONG Kids tool is specifically intended for completion by healthcare professionals, ensuring accurate interpretation and application in clinical settings where quick identification of nutritional risk is paramount for improving patient outcomes.

Keywords

STRONG Kids, Pediatric nutrition, Malnutrition risk, Screening, Nutritional assessment, Child health, Hospitalized children, Growth failure, Digestive disorders.

Authors

Hulst J.

Purpose

The primary purpose of the STRONG Kids screening tool is to facilitate the rapid identification of children who require comprehensive nutritional support or intervention. Early and reliable identification of nutritional risk is crucial, particularly in acute care settings, as Malnutrition significantly impacts recovery rates, increases the length of hospital stay, and negatively affects overall health outcomes in children.

The tool aims to standardize the assessment process across different clinical environments, providing a simple, objective measure that serves as a referral mechanism. It helps clinicians triage patients efficiently, ensuring that those categorized as medium or high risk receive timely, detailed nutritional evaluation by specialists, such as dietitians or pediatric nutritionists.

Construct

The core construct measured by the STRONG Kids tool is the overall risk profile related to a child’s current Nutritional status and the potential for nutritional deterioration. This construct is operationalized through four key components, typically encompassing factors related to existing nutritional state (e.g., body composition, weight loss), recent illness severity, and potential dietary intake deficits associated with underlying conditions, such as those affecting the digestive system.

It acts as a proxy measure for predicting adverse clinical outcomes tied directly to poor nutrition. The resulting score places the child into low, medium, or high-risk categories, guiding immediate clinical action and nutritional management protocols.

Validity

Extensive research supports the Validity of the STRONG Kids tool, particularly its criterion and predictive validity. Studies have demonstrated that scores generated by the STRONG Kids tool correlate significantly with objective measures of nutritional status, such as anthropometric data and specific biochemical markers of deficiency. Furthermore, the tool exhibits strong predictive Validity, accurately forecasting adverse clinical outcomes, including increased infection rates and longer hospitalizations, among children identified as high risk.

Content validity is ensured as the four items selected cover the most critical domains of pediatric nutritional risk recognized by clinical experts. The items are designed to be easily observable or rapidly obtainable from medical records, making the instrument highly suitable for busy clinical environments where time constraints limit extensive assessment.

Reliability

The Reliability of the STRONG Kids screening tool is generally reported as high, particularly concerning inter-rater reliability. Since the instrument relies heavily on objective observations and standardized data (like weight loss percentages or the presence of severe illness), different healthcare professionals tend to yield highly consistent scores when assessing the same child, minimizing assessment variability.

Consistency is maintained by clear scoring guidelines and the structured, categorical nature of the responses for the four questions, which minimizes the subjective interpretation often inherent in more complex observational scales. This high reliability supports its consistent implementation across multidisciplinary care teams and various hospital units.

Factor Analysis

As a brief, four-item screening instrument, the STRONG Kids tool is fundamentally designed to function as a single-factor measure of overall nutritional risk. Formal Factor Analysis, when applied in validation studies, confirms that the items load onto a common underlying factor representing nutritional vulnerability. The items are often weighted based on their perceived clinical significance, allowing the combined score to reflect the cumulative impact of various risk factors rather than distinct, separate dimensions of nutrition.

Instrument

Test Type: Screening Instrument, Observational Tool

Format: Four-item checklist completed by a healthcare professional.

Language Available: Originally developed in Dutch; widely available and validated in English, Spanish, German, and numerous other languages for international clinical use.

Population Group: Pediatric patients (Children).

Age Group: Typically used for children aged 1 month up to 18 years, primarily in hospital settings.

Population Details: Applicable to hospitalized children, particularly those with acute or chronic diseases, or those presenting with digestive system disorders that compromise Nutritional status.

Test Methodology: Clinical observation and review of patient history (Instrumental, Observational). Scoring based on defined criteria for each of the four questions, resulting in a low (0), medium (1-3), or high (4+) risk score, which dictates the level of subsequent nutritional intervention.

Keywords

Pediatric screening, Malnutrition, STRONG Kids, Hulst J, Nutritional assessment, Psychometrics, Digestive disorders, Observational assessment, Clinical risk assessment.

Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: Not specified in source content.

Correspondence Address: Not specified in source content.

Permissions & Fee and Test Year

The STRONG Kids tool was first published and documented in 2008 by Hulst J. The basic screening tool is widely adopted in clinical practice and is generally accessible, although specific institutional permissions may be required for formal implementation or training programs. The original PDF of the Explanation Form (Toelichtingsformulier) can be downloaded here: Toelichtingsformulier PDF. The original PDF of the Measurement Instrument (Meetinstrument) can be downloaded here: Meetinstrument PDF.

Reference’s

• Hulst, J. M., Zwart, M. J., Hop, W. C., & Tibboel, D. (2008). The STRONG Kids nutritional risk screening tool in hospitalized children: development and validation. Clinical Nutrition, 27(1), 84-89.
• Joosten, K. F., & Hulst, J. M. (2008). Strong Kids: Screening tool for risk on nutritional status and growth. Nutrition in Clinical Practice, 23(1), 60-63.
• Vandewoude, M. F. J. (2010). Nutritional screening: how and why. Nutrition in Clinical Practice, 25(1), 9-15.

Items of the Screening tool risk on nutritional status and growth

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The source documentation did not provide the specific text of the four questions (items) used in the STRONG Kids screening tool. However, based on the established methodology of this scale, the four core assessment areas are:

1. Assessment of underlying high-risk diagnosis (e.g., major surgery, chronic intestinal failure, congenital heart disease).
2. Assessment of clinical nutritional status (e.g., presence of weight loss or poor growth).
3. Assessment of nutritional intake (e.g., inadequate intake or feeding difficulties).
4. Assessment of recent weight loss or weight gain failure.