Validity of Nutrition Screening Tools for Risk of Malnutrition Among Pediatric Oncology Populations: A Systematic Review and Meta-Analysis

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Abstract Context The lack of standardized procedures for malnutrition risk screening in the pediatric oncology population. Objective This systematic review and meta-analysis aimed to evaluate the validity of nutritional screening tools for identifying the risk of malnutrition in pediatric oncology patients. Data sources A systematic review of studies identified in 4 databases (Web of Science, Scopus, OVID and CINAHL) were searched from inception to April 2025. Data Extraction Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Data Analysis Diagnostic accuracy outcomes were analyzed using a Bayesian bivariate random-effects model via MetaBayesDTA. Summary estimates were pooled where applicable, and summary receiver operating characteristic curves were generated to illustrate diagnostic performance. Results Of 1377 articles retrieved, 7 met inclusion criteria for the systematic review, and 6 were included in the pooled meta-analysis. These studies evaluated 4 different nutrition screening tools, including the Screening Tool for Childhood Cancer (SCAN), Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), Pediatric Yorkhill Malnutrition Score (PYMS), and Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP). The meta-analysis evaluated the diagnostic performance of 3 nutritional risk screening tools—SCAN, STRONGkids, and PYMS—against anthropometric measurements and/or pediatric Subjective Global Nutritional Assessment (SGNA) as reference standards. SCAN demonstrated good to excellent sensitivity against body mass index (BMI; 89.0%; 95% CrI, 68.8-95.9) and SGNA (95.0%; 95% CrI, 72.9-98.9), though with poor to insufficient specificity. PYMS showed excellent sensitivity (91.0%; 95% CrI, 59.1-97.8), but poor specificity (43.3%; 95% CrI, 26.1-66.6) compared to BMI. Conclusion SCAN and PYMS demonstrated high sensitivity but low specificity in identifying pediatric cancer patients at risk of malnutrition. Future research should focus on validation studies, aimed at standardizing the nutritional risk screening process in the pediatric oncology population. Systematic Review Registration PROSPERO registration No. [CRD420251022898].