Paediatric in-patients are at high risk of malnutrition but validated paediatric screening tools suitable for use by nursing staff are scarce. The present study aimed to assess the diagnostic accuracy of the new Paediatric Yorkhill Malnutrition Score (PYMS). During a pilot introduction in a tertiary referral hospital and a district general hospital, two research dietitians assessed the validity of the PYMS by comparing the nursing screening outcome with a full dietetic assessment, anthropometry and body composition measurements. An additional PYMS form was completed by the research dietitians to assess its inter-rater reliability with the nursing staff and for comparison with the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Paediatric Subjective Global Nutritional Assessment (SGNA). Of the 247 children studied, the nurse-rated PYMS identified 59 % of those rated at high risk by full dietetic assessment. Of those rated at high risk by the nursing PYMS, 47 % were confirmed as high risk on full assessment. The PYMS showed moderate agreement with the full assessment (k ¼ 0·46) and interrater reliability (k ¼ 0·53) with the research dietitians. Children who screened as high risk for malnutrition had significantly lower lean mass index than those at moderate or low risk, but no difference in fat. When completed by the research dietitians, the PYMS showed similar sensitivity to the STAMP, but a higher positive predictive value. The SGNA had higher specificity than the PYMS but much lower sensitivity. The PYMS screening tool is an acceptable screening tool for identifying children at risk of malnutrition without producing unmanageable numbers of false-positive cases.

All inpatients should be screened for malnutrition (1) but validated paediatric tools for use by nursing staff are scarce. The Paediatric Yorkhill Malnutrition score (PYMS) was developed based on ESPEN guidelines (2) . Its development, performance (3) , criterion validity, inter-rater reliability (4) and impact on clinical practice (5) have been assessed. This study compared the PYMS with other similar paediatric tools.Two research dietitians screened malnutrition using the PYMS, the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) (6) and the paediatric Subjective Global Nutritional Assessment (SGNA) (7) in inpatients (1-16 years) from a tertiary paediatric (n = 225) and district general hospital (n = 22).Two hundred and forty seven children consented to the study. The prevalence of malnutrition varied between the different tools. Compared to PYMS, STAMP identified more patients as being at risk, while SGNA identified fewer (Table 1). Eighty percent (198/247) of the patients were classified at the same risk of malnutrition between STAMP and PYMS and 81 % (199/ 247) between SGNA and PYMS ( Table 2). The agreement between STAMP and PYMS was moderate (k = 0.47 95 % CI [0.34-0.61]) and between SGNA and PYMS slight (k = 0.12 95 % CI [-0.11-0.34]). PYMS identified all the children who screened at risk by SGNA but only 52 % of those screened at risk by STAMP (Table 2). Likewise 20 % and 9 % of the patients screened at low risk using SGNA and STAMP were classified at risk by PYMS (Table 2). STAMP identified a greater percentage of inpatients as being at medium or high risk, while PYMS identified a more manageable proportion. PYMS agreed poorly with SGNA which identifies malnourished rather than patients at risk of developing malnutrition. Comparison against dietetic assessment is needed to explore which screening tool has better diagnostic validity.