Nutrition Screening Pediatrics

NSP: Validity and Reliability Criteria (2018)

Cut Points Used to Interpret Validity, Reliability and Agreement of Pediatric Nutrition Screening Tools

The level of validity, reliability and agreement was assessed for the individual studies, then findings were aggregated for the studies examining each tool, and an overall classification for each of these measures was assigned (Table 1). To determine the overall validity of each malnutrition screening tool, the workgroup applied the aggregated data for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each tool, to the algorithm below (Figure 1) to determine whether validity was high, moderate, or low.

When determining overall validity for a tool, sensitivity and NPV were given more weight than specificity and PPV in the algorithm. This approach reduces the chance of false negatives, that is, identifying an individual as not being at risk for malnutrition when malnutrition is actually present. This is appropriate when evaluating screening tools, since the tool attempts to identify risk and the need for nutrition assessment, as opposed to a diagnosis. Similar procedures were followed to determine the overall reliability and agreement for each tool. The kappa statistic was the preferred method of measurement since it is a more robust and conservative estimate compared to other measures of agreement. However, if kappa values were not reported, Cronbach’s alpha or intraclass correlation was accepted.

Table 1. Cut points for interpreting data of pediatric malnutrition screening tools. Download a copy of the Table 1 (PDF).

Criteria for Individual Study Results Overall Classification for Each Tool
Validity Results
Se, Sp, PPV, NPVa  Overall Degree of Se, Sp, PPV, NPV
90 to 100%, Excellent High
80 to 90%, Good Moderate
70 to 80%, Fair Low
60 to 70%, Insufficent Low
50 to 60%, Poor Low
Reliability and Agreement Results
Kappa Valueb Overall Level of Agreement and Reliability
Above 0.90, Almost Perfect     High
0.80 to 0.90, Strong     High
0.60 to 0.79, Moderate     Moderate
0.40 to 0.59, Weak     Low
0.21 to 0.39, Minimal   Low
0 to 0.20, None     Low
Cronbach’s Alpha Valuec     Overall Level of Internal Consistency
α ≥ 0.9, Excellent   High
0.9 > α ≥ 0.8, Good     High
0.8 > α ≥ 0.7, Acceptable     Moderate
0.7 > α ≥ 0.6, Questionable     Low
0.6 > α ≥ 0.5, Poor     Low
0.5 > α, Unacceptable     Low
ICC Valued     Overall Level of Test-Retest Reliability
>0.90, Excellent     High
0.75 to 0.9, Good     High
0.5 to 0.75, Moderate     Moderate
<0.5, Poor   Low

Abbreviations: Se=sensitivity, Sp=Specificity, PPV=Positive predictive value, NPV=Negative predictive value
aCriteria were set based on Neelemaat F, Meijers J, Kruizenga H, van Ballegooijen H, van Bokhorst-de van der Schueren M. Comparison of five malnutrition screening tools in one hospital inpatient sample. Journal of clinical nursing. 2011; 20 (15-16): 2,144-2,152. PMID: 21535274.
bCriteria were set based on McHugh ML. Interrater reliability: the kappa statistic. Biochemia medica. 2012; 22(3): 276-282. PMID: 23092060.
cα=alpha. Criteria were set based on Tavakol M, Dennick R. Making sense of Cronbach's alpha. International journal of medical.420 education. 2011; 2: 53-55.
dICC=intraclass correlation coefficient. Criteria were set based on Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. Journal of chiropractic medicine. 2016; 15(2): 155-163.

Figure 1. Algorithm to determine high, moderate, or low validity for each malnutrition screening tool