Age-stratified validation and interrater reliability of the screening tool for nutritional risk for childhood cancer in hospitalized children

Objective

To evaluate the reliability, construct, and criterion validity of the screening tool for childhood cancer (SCAN), stratified by age in oncology patients admitted to a tertiary referral hospital.

Methods

Hospitalized children from birth to 18 years old, with an oncological diagnosis and expected length of stay (LOS) of >24 hours were included. Interrater and intrarrater agreements were used to evaluate the reliability of SCAN. Construct validity and criterion validity were explored in SCAN. Also, predictive validity was explored by comparing SCAN risk categories against LOS.

Results

Three hundred ninety-four children were included in the study. The scores obtained after dietitians and physicians used SCAN showed good agreement (ICC = 0.80, 95%CI 0.71–0.86, P < 0.001). The intrarrater agreement within the evaluation of the same dietitian to the same group of patients was also good (ICC = 0.83, 95%CI 0.75–0.88, P < 0.001). After applying SCAN, 66.2% of participants scored >3 points, classified as at risk of malnutrition. The agreement observed when comparing the risk classification given by the tool with the malnutrition assessment using anthropometry variables as the criterion reference was fair (κ = 0.22, 95%CI 0.15–0.29, P < 0.001). Predictive validity indicated a slight agreement (κ = 0.16, 95%CI 0.08–0.25, P < 0.001) between malnutrition risk by SCAN and LOS. When assessing construct validity, comparing the scores given by SCAN with those provided by STRONGkids, a fair agreement was found (κ = 0.21, 95%CI 0.15–0.26, P < 0.001).

Conclusions

Our results show that SCAN is a reliable and valid tool for detecting malnutrition in oncology pediatric patients upon hospital admission.