Improving assessment of child growth in a pediatric hospital setting

• Type of Material: Article
• Authors: Priya M. Gupta, Emory University; Emily Wieck, Emory University; Joel Conkle, UNICEF; Kristina A. Betters, Vanderbilt University; Anthony Cooley, Emory University; Selena Yamasaki, Childrens Healthcare Atlanta; Natasha Laibhen-Parkes, Childrens Healthcare Atlanta; Parminder Suchdev, Emory University
• Language: English
• Date: 2020-09-03
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2020.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12887-020-02289-1
• Title of Journal or Parent Work: BMC Pediatrics
• Volume: 20
• Issue: 1
• Start Page: 419
• End Page: 419
• Grant/Funding Information: The authors have no financial relationships relevant to this article to disclose.
• Keywords: Science & Technology; Quality of life; Accuracy; Pediatrics; Child health; Life Sciences & Biomedicine; Tool; Anthropometry; Growth; Nutrition & Dietetics; Measuring height
• Research Categories: Health Sciences, Human Development; Health Sciences, Nutrition; Health Sciences, Health Care Management; Health Sciences, Public Health

Abstract

Background Accurate anthropometric measurements are essential for assessing nutritional status, monitoring child growth, and informing clinical care. We aimed to improve height measurements of hospitalized pediatrics patients through implementation of gold standard measurement techniques. Methods A quality improvement project implemented computerized training modules on anthropometry and standardized wooden boards for height measurements in a tertiary children’s hospital. Heights were collected pre- and post-intervention on general pediatric inpatients under 5 years of age. Accuracy of height measurements was determined by analyzing the variance and by comparing to World Health Organization’s defined biologically plausible height-for-age z-scores. Qualitative interviews assessed staff attitudes. Results Ninety-six hospital staff completed the anthropometry training. Data were available on 632 children pre- and 933 post-intervention. Training did not increase the proportion of patients measured for height (78.6% pre-intervention vs. 75.8% post-intervention, p = 0.19). Post-intervention, wooden height boards were used to measure height of 34.8% patients, while tape measures and wingspan accounted for 42.0% and 3.5% of measurements, respectively. There was no improvement in the quality of height measurements based on plausibility (approximately 3% height-for-age z-scores measurements flagged out of range pre- and post-intervention), digit preference (13.4% of digits pre- and 12.3% post-intervention requiring reclassification), or dispersion of measurements (height-for-age z-scores standard deviation 1.9 pre- and post-intervention). Staff reported that using the wooden board was too labor consuming and cumbersome. Conclusions Our findings suggest that efforts to improve anthropometric measurements of hospitalized children have multiple obstacles, and further investigation of less cumbersome methods of measurements may be warranted.