Table 3

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

StudyToolReference standardSe (%)Sp (%)RatingPPV (%)NPV (%)Inter-/intra observer agreement (kappa)Agreement with reference standard/other screening toolsRating kappa
Chourdakis et al63PYMSWHO BMI <-2SD*90.91†81.97†g21.90†99.39†
STAMP77.27†81.21†f18.61†98.47†
STRONGkids45.45*91.74†p23.44†96.80†
PYMSMUAC <-2SD*66.67†75.19†f7.55†98.67†
STAMP81.82†78.31†f9.89†99.33†
STRONGkids41.67†92.80†p15.15†98.10†
PYMSTSFT <-2SD*80.00†75.07†f4.08†99.65†
STAMP40.00†78.09†p2.50†98.93†
STRONGkids20.00†92.78†p3.7 0†98.82†
PYMSSTAMP*58.70†88.37†f59.31†88.11†STAMP: k=0.47
(95% CI 0.42 to 0.53)		m
STAMPSTRONGkids*77.30†84.11†f36.82†96.87†STRONGkids: k=0.47
(95% CI 0.42 to 0.53)		m
STRONGkidsPYMS*31.40†96.54†p74.51†81.38†PYMS: k=0.35
(95% CI 0.28 to 0.42)		f
Durakbaşa et al60STRONGkidsWHO
Acute malnutrition: WFH, BMI‡48.00†65.77†p13.64†91.82†
Chronic malnutrition: HFA‡52.17†45.18†p6.82†96.54†
Galera-
Martinez et al61		STRONGkids expertsWHO BMI <-2SD*37.50†91.16†p13.64†97.51†Interobserver: k=0.72
(95% CI 0.63-0.80)m
STRONGkids non-experts37.50†94.42†p20.00†97.60†
STAMP experts87.50†82.79†g15.90†99.44†Interobserver: k=0.74
(95% CI 0.67-0.81)m
STAMP non-experts62.50†79.53†f10.20†98.27†
Gerasimidis et al7PYMScFull dietetic assessment*5992f4795Interobserver: 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
PYMSd8587g4498ARd: k=0.51
(95% CI 0.40 to 0.70)		m
STAMPd8178f3197STAMPd: k=0.34
(95% CI 0.20 to 0.50)		f
SGNAd15100p10091SGNAd: k=0.24
(95% CI 0.10 to 0.50)		f
Hulst et al2STRONGkidsWHO (HFA, WFH)‡75.32†41.47†p22.57†88.13†
Huysentruyt et al51STRONGkidsWHO (WFH, HFA)‡71.9e49.1ep11.9e94.8eInterobserver: k=0.61
69f48.4fp10.4f94.8fIntraobserver: k=0.66
Johnson et al42NNSTUK-WHO growth chart (WFA)89.675.1f32.998.1
Ling et al52STAMPNutritional intervention‡100†40†p41.94†100†
STRONGkids100†§38.89†§p35.29†§100†§
Mahdavi et al38SGAAnthropometric and biochemical measurements WHO (WFA, HFA, WFH, TSFT and serum transferrin)88.2445.83p60.6180.49ARi: k=0.336f
Mărginean et al53STRONGkidsWHO (WFH, HFA)‡97.00†50.29†f53.30†96.63†AR: k=0.61su
Modified STRONGkids97.00†65.50†f62.18†97.39†AR: k=0.716su
Martinez-
Nadal et al64		CAN scoreRoher’s Ponderal index48.90†95.47†p44.60†96.16†
McCarthy et al32STAMPFull nutritional assessment*70 (95% CI 51 to 84)91 (95% CI 86 to 94)f54.8 (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
McDonald41Nutrition Risk ScreeningCFF Consensus Report criteria‡8475f82†77†Interobserver: k=0.85a
Tool in CFFull dietetic assessment‡8678f84†80†
Moeeni et al54PYMSWHO (WFH, HFA, BMI if WFH or HFA missing)‡90.00†31.46†p30.68†90.32†
STRONGkids83.33†49.44†p35.71†89.80†
STAMP90.00†37.08†p32.53†91.67†
Moeeni et al55STRONGkidsWHO (BMI, WFA, HFA, WFH)84k/Interobserver: k=0.65j
simplified90I/
Murphy et al39SCANSGNA100 (95% CI 76 to 100)39 (95% CI 17 to 64)p56 (95% CI 35 to 76)100 (95% CI 59 to 100)
Rub et al57STAMPFull nutritional assessment‡47.6 (95% CI 28.3 to 67.6)94.9 (95% CI 81 to 99)p83.377.1AR: k=0.47
(95% CI 0.35 to 0.79)		m
STAMP-modified76.19 (95% CI 54.91 to 89.37)82.05 (95% CI 67.33 to 91.02)f69.686.5AR: k=0.57
(95% CI 0.35 to 0.79)		m
Soundarya et al62CAN ScoreRoher’s Ponderal index65.286.4f60.288.7
60.26†88.74†f65.28†86.40†
BMI84.773.6f50.493.8
50.41†93.85†f84.72†73.68†
Roher’s Ponderal index+BMI84.772.8f49.593.7
Mid arm circumference/head41.677.6p37.080.8
circumference ratio37.04†80.82†p41.67†77.63†
Souza Dos
Santos et al40		Nutrition screening tool for pediatric patients with CFCFF Consensus Report criteria‡72.471.7f58.33†82.61†AR: k=0.418 (p<0.001)m
Nutritional risk screening tool proposed by McDonald‡8595.2g94.44†86.96†AR: k=0.804 (p<0.001)su
Spagnuolo et al58STRONGkidsWHO (BMI, HFA for acute and chronic malnutrition)‡71 (95% CI 48 to 89)53 (95% CI 43 to 63)f21 (95% CI 17 to 25)85 (95% CI 85 to 90)
Thomas et al.65STAMPWHO (HFA, WFH, BMI)‡63.236.3p35.663.8AR: k=−0.005n
PMST (STAMP-modified)94.429.0p40.591.1AR: k=0.177s
PYMS26.167.1p34.358.0AR: k=−0.71n
Wang et al6STAMPWHO (WHA, HFA, BMI)‡10073.3f65.2100AR: k=0.603m
White et al9PNSTWHO and CDC 2000
BMI ≤ −2SD‡89.366.2f22.598.4
WFA ≤ −2SD‡89.565.0f15.398.9
HFA ≤ −2SD‡55.662.4f4.597.8
SGNA‡77.882.1f69.387.6
SGNAWHO and CDC 2000
BMI ≤ −2SD‡96.572.5f27.799.5
WFA ≤ −2SD‡85.769.7f17.898.5
HFA ≤ −2SD‡46.266.5p6.096.4
Wiskin et al59STAMPICD-10‡100†0†p6.52†NA†AR: k=−0.014n
STRONGkids1000†p6.52†NA†AR: k=−0.013n
SPNRS100†0†p6.52†NA†AR: k=−0.013n
PYMS100†53.49†f13.04†100†AR: k=0.079s
STAMPSTRONGkids‡100†NA†p100†NA†STRONGkids: k=0.774su
STRONGkidsSPNRS‡100†NA†p100†NA†SPNRS: k=0.732su
PYMS‡50†NA†p100†0†PYMS: k=0.332f
SPNRSSPNRS‡100†NA†p100†NA†SPNRS: k=0.600m
PYMS‡50†NA†p100†0†PYMS: k=0.270f
PYMS‡50†NA†p100†0†PYMS: k=0.236f
Wong et al14STAMPFull dietetic assessment‡83.366.7f78.173.6Interobserverg: k=0.752AR: k=0.507
(95% CI 0.646 to 1.000)		m
PYMS‡Intraobserverh: k=0.635PYMS: k=0.314
(95% CI 0.076 to 0.552)		f
Wonoputri et al56PYMSSGNA‡95.31 (95% CI 0.87 to 0.98)76.92 (95% CI 63 to 86)f83.56 (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
STAMP100 (95% CI 0.94 to 1)11.54 (95% CI 5 to 23)p58.2 (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
STRONGkids100 (95% CI 94 to 100)7.7 (95% CI 3 to 18)p57.14 (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.