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. 2019 May 27;9(5):e025444. doi: 10.1136/bmjopen-2018-025444

Table 3.

Sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV and NPV) and agreement of studies included in the systematic review

Study Tool Reference standard Se (%) Sp (%) Rating PPV (%) NPV (%) Inter-/intra observer agreement (kappa) Agreement with reference standard/other screening tools Rating kappa
Chourdakis et al 63 PYMS WHO BMI <-2SD* 90.91† 81.97† g 21.90† 99.39†
STAMP 77.27† 81.21† f 18.61† 98.47†
STRONGkids 45.45* 91.74† p 23.44† 96.80†
PYMS MUAC <-2SD* 66.67† 75.19† f 7.55† 98.67†
STAMP 81.82† 78.31† f 9.89† 99.33†
STRONGkids 41.67† 92.80† p 15.15† 98.10†
PYMS TSFT <-2SD* 80.00† 75.07† f 4.08† 99.65†
STAMP 40.00† 78.09† p 2.50† 98.93†
STRONGkids 20.00† 92.78† p 3.7 0† 98.82†
PYMS STAMP* 58.70† 88.37† f 59.31† 88.11† STAMP: k=0.47
(95% CI 0.42 to 0.53)		 m
STAMP STRONGkids* 77.30† 84.11† f 36.82† 96.87† STRONGkids: k=0.47
(95% CI 0.42 to 0.53)		 m
STRONGkids PYMS* 31.40† 96.54† p 74.51† 81.38† PYMS: k=0.35
(95% CI 0.28 to 0.42)		 f
Durakbaşa et al 60 STRONGkids WHO
Acute malnutrition: WFH, BMI‡ 48.00† 65.77† p 13.64† 91.82†
Chronic malnutrition: HFA‡ 52.17† 45.18† p 6.82† 96.54†
Galera-
Martinez et al 61 		STRONGkids experts WHO BMI <-2SD* 37.50† 91.16† p 13.64† 97.51† Interobserver: k=0.72
(95% CI 0.63-0.80)m
STRONGkids non-experts 37.50† 94.42† p 20.00† 97.60†
STAMP experts 87.50† 82.79† g 15.90† 99.44† Interobserver: k=0.74
(95% CI 0.67-0.81)m
STAMP non-experts 62.50† 79.53† f 10.20† 98.27†
Gerasimidis et al 7 PYMSc Full dietetic assessment* 59 92 f 47 95 Interobserver: k=0.53
(95% CI 0.38 to 0.67)b 		ARc: k=0.46
(95% CI 0.27 to 0.64)		 m
STAMPc: k=0.47
(95% CI 0.34 to 0.61)		 m
SGNAc: k=0.12
(95% CI −0.11- −0.34)		 s
PYMSd 85 87 g 44 98 ARd: k=0.51
(95% CI 0.40 to 0.70)		 m
STAMPd 81 78 f 31 97 STAMPd: k=0.34
(95% CI 0.20 to 0.50)		 f
SGNAd 15 100 p 100 91 SGNAd: k=0.24
(95% CI 0.10 to 0.50)		 f
Hulst et al 2 STRONGkids WHO (HFA, WFH)‡ 75.32† 41.47† p 22.57† 88.13†
Huysentruyt et al 51 STRONGkids WHO (WFH, HFA)‡ 71.9e 49.1e p 11.9e 94.8e Interobserver: k=0.61
69f 48.4f p 10.4f 94.8f Intraobserver: k=0.66
Johnson et al 42 NNST UK-WHO growth chart (WFA) 89.6 75.1 f 32.9 98.1
Ling et al 52 STAMP Nutritional intervention‡ 100† 40† p 41.94† 100†
STRONGkids 100†§ 38.89†§ p 35.29†§ 100†§
Mahdavi et al 38 SGA Anthropometric and biochemical measurements WHO (WFA, HFA, WFH, TSFT and serum transferrin) 88.24 45.83 p 60.61 80.49 ARi: k=0.336 f
Mărginean et al 53 STRONGkids WHO (WFH, HFA)‡ 97.00† 50.29† f 53.30† 96.63† AR: k=0.61 su
Modified STRONGkids 97.00† 65.50† f 62.18† 97.39† AR: k=0.716 su
Martinez-
Nadal et al 64 		CAN score Roher’s Ponderal index 48.90† 95.47† p 44.60† 96.16†
McCarthy et al 32 STAMP Full nutritional assessment* 70 (95% CI 51 to 84) 91 (95% CI 86 to 94) f 54.8 (95% CI 38.8 to 69.8) 94.9 (95% CI 90.5 to 97.4) Interobserver: k=0.92
(95% CI 0.76 to 1.00)		 AR: k=0.54
(95% CI 0.46 to 0.62)		 m
McDonald41 Nutrition Risk Screening CFF Consensus Report criteria‡ 84 75 f 82† 77† Interobserver: k=0.85a
Tool in CF Full dietetic assessment‡ 86 78 f 84† 80†
Moeeni et al 54 PYMS WHO (WFH, HFA, BMI if WFH or HFA missing)‡ 90.00† 31.46† p 30.68† 90.32†
STRONGkids 83.33† 49.44† p 35.71† 89.80†
STAMP 90.00† 37.08† p 32.53† 91.67†
Moeeni et al 55 STRONGkids WHO (BMI, WFA, HFA, WFH) 84k / Interobserver: k=0.65j
simplified 90I /
Murphy et al 39 SCAN SGNA 100 (95% CI 76 to 100) 39 (95% CI 17 to 64) p 56 (95% CI 35 to 76) 100 (95% CI 59 to 100)
Rub et al 57 STAMP Full nutritional assessment‡ 47.6 (95% CI 28.3 to 67.6) 94.9 (95% CI 81 to 99) p 83.3 77.1 AR: k=0.47
(95% CI 0.35 to 0.79)		 m
STAMP-modified 76.19 (95% CI 54.91 to 89.37) 82.05 (95% CI 67.33 to 91.02) f 69.6 86.5 AR: k=0.57
(95% CI 0.35 to 0.79)		 m
Soundarya et al 62 CAN Score Roher’s Ponderal index 65.2 86.4 f 60.2 88.7
60.26† 88.74† f 65.28† 86.40†
BMI 84.7 73.6 f 50.4 93.8
50.41† 93.85† f 84.72† 73.68†
Roher’s Ponderal index+BMI 84.7 72.8 f 49.5 93.7
Mid arm circumference/head 41.6 77.6 p 37.0 80.8
circumference ratio 37.04† 80.82† p 41.67† 77.63†
Souza Dos
Santos et al 40 		Nutrition screening tool for pediatric patients with CF CFF Consensus Report criteria‡ 72.4 71.7 f 58.33† 82.61† AR: k=0.418 (p<0.001) m
Nutritional risk screening tool proposed by McDonald‡ 85 95.2 g 94.44† 86.96† AR: k=0.804 (p<0.001) su
Spagnuolo et al 58 STRONGkids WHO (BMI, HFA for acute and chronic malnutrition)‡ 71 (95% CI 48 to 89) 53 (95% CI 43 to 63) f 21 (95% CI 17 to 25) 85 (95% CI 85 to 90)
Thomas et al.65 STAMP WHO (HFA, WFH, BMI)‡ 63.2 36.3 p 35.6 63.8 AR: k=−0.005 n
PMST (STAMP-modified) 94.4 29.0 p 40.5 91.1 AR: k=0.177 s
PYMS 26.1 67.1 p 34.3 58.0 AR: k=−0.71 n
Wang et al 6 STAMP WHO (WHA, HFA, BMI)‡ 100 73.3 f 65.2 100 AR: k=0.603 m
White et al 9 PNST WHO and CDC 2000
BMI ≤ −2SD‡ 89.3 66.2 f 22.5 98.4
WFA ≤ −2SD‡ 89.5 65.0 f 15.3 98.9
HFA ≤ −2SD‡ 55.6 62.4 f 4.5 97.8
SGNA‡ 77.8 82.1 f 69.3 87.6
SGNA WHO and CDC 2000
BMI ≤ −2SD‡ 96.5 72.5 f 27.7 99.5
WFA ≤ −2SD‡ 85.7 69.7 f 17.8 98.5
HFA ≤ −2SD‡ 46.2 66.5 p 6.0 96.4
Wiskin et al 59 STAMP ICD-10‡ 100† 0† p 6.52† NA† AR: k=−0.014 n
STRONGkids 100 0† p 6.52† NA† AR: k=−0.013 n
SPNRS 100† 0† p 6.52† NA† AR: k=−0.013 n
PYMS 100† 53.49† f 13.04† 100† AR: k=0.079 s
STAMP STRONGkids‡ 100† NA† p 100† NA† STRONGkids: k=0.774 su
STRONGkids SPNRS‡ 100† NA† p 100† NA† SPNRS: k=0.732 su
PYMS‡ 50† NA† p 100† 0† PYMS: k=0.332 f
SPNRS SPNRS‡ 100† NA† p 100† NA† SPNRS: k=0.600 m
PYMS‡ 50† NA† p 100† 0† PYMS: k=0.270 f
PYMS‡ 50† NA† p 100† 0† PYMS: k=0.236 f
Wong et al 14 STAMP Full dietetic assessment‡ 83.3 66.7 f 78.1 73.6 Interobserverg: k=0.752 AR: k=0.507
(95% CI 0.646 to 1.000)		 m
PYMS‡ Intraobserverh: k=0.635 PYMS: k=0.314
(95% CI 0.076 to 0.552)		 f
Wonoputri et al 56 PYMS SGNA‡ 95.31 (95% CI 0.87 to 0.98) 76.92 (95% CI 63 to 86) f 83.56 (95% CI 73 to 90) 93.02 (95% CI 81 to 97) ARe: k=0.348
(95% CI 0.191 to 0.506)		 f
ARf: k=0.125
(95% CI 0 to 0.299)		 s
STAMP 100 (95% CI 0.94 to 1) 11.54 (95% CI 5 to 23) p 58.2 (95% CI 48 to 67) 100 (95% CI 61 to 100) ARe: k=0.018
(95% CI 0 to 0.140)		 s
ARf: k=0
(95% CI 0 to 0.140)		 s
STRONGkids 100 (95% CI 94 to 100) 7.7 (95% CI 3 to 18) p 57.14 (95% CI 47.9 to 65.9) 100 (95% CI 51 to 100) ARe: k=0.028
(95% CI 0 to 0.149)		 s
ARf: k=0
(95% CI 0 to 0.144)		 s

*low and medium malnutritional risk versus high.

†not reported by authors (ie, calculated in the present study).

‡low versus medium and high malnutritional risk.

§error in reported data.

a

among six registered dietitians on 18 patients.

b

two research dietitians and ward nursing staff.

c

nurse-rated malnutrition risk screening tool.

d

research-dietitian-rated malnutrition risk screening tool.

e

reference standard: acute malnutrition (WFH <-2SD).

f

reference standard: chronic malnutrition (HFA <-2SD).

g

registered dietitian versus nurses.

h

registered dietitian.

i

on 93 patients.

j

paediatrician versus nurses.

k

nurse.

l

paediatrician.

m

registered dietitian/physician specialised in paediatric nutrition versus nurse non-specialized in nutrition or paediatric resident.

AR, agreement with the reference standard used; for other abbreviations and acronyms, see table 1.