NUTRI-REAPED study: nutritional assessment of French critically ill children and nutrition practice survey in French-speaking pediatric intensive care units

Jacquot, Aurélien; Valla, Frédéric Victor; Mura, Thibault; Tume, Lyvonne Nicole; Bertet, Héléna; Ford-Chessel, Carole; Milesi, Christophe; Cambonie, Gilles; De Luca, Arnaud; Gaillard-Le Roux, Bénédicte

doi:10.1186/s13613-019-0493-z

Table 2 Comparison of nurses’ and physicians’ responses

From: NUTRI-REAPED study: nutritional assessment of French critically ill children and nutrition practice survey in French-speaking pediatric intensive care units

	Cohen’s Kappa^a coefficient (IC95%)	Agreement rate %	p value for balance of discordant responses^b	Detailed discrepancy
Is nutrition support considered a priority?	0.29 [− 0.06; 0.64]	80.6	0.53
Is there a nutrition support team in the unit?	0.47 [0.18; 0.76]*	75,0	0.32
Is a dietician involved in nutrition care?	0.28 [− 0.03; 0.60]	66.7	0.25
Are there written local nutrition guidelines?	0.26 [− 0.04; 0.57]	63.9	0.17
How often are children weighed?	0.12 [− 0.20; 0.44]	77.4	0.03	Nurses answer “all the time” more frequently
How often is length/height measured?	0.38 [0.13; 0.64]*	65.7	0.20
How is nutritional status assessed?	0.30 [0.05; 0.55]*	64.5	0.09
Are nutritional indices (such as BMI) calculated?	0.17 [− 0.05; 0.39]	55.6	0.05	Physicians answer « no » more often
How are nutritional goals set?	0.03 [− 0.04; 0.10]	25.7	< 0.01	Nurses answer “I don’t know” more often Physicians answer “recommended dietary allowance” more often
Knowledge about enteral solutions	0.06 [− 0.17; 0.30]	45.7	0.07	Nursing teams consider their knowledge insufficient more often
Use of fibers in enteral nutrition	0.22 [− 0.04; 0.48]	60.0	0.34
Delay to start enteral nutrition	0.06 [− 0.13; 0.25]	40.0	0.39
Route and modalities of enteral nutrition	0.36 [0.10; 0.61]*	57.1	0.33
Patients’ positioning while on enteral nutrition	0.14 [− 0.13; 0.41]	54.3	0.01	Nurses answer “all the time” more often
Gastric residual volume measurements	0.54 [0.31; 0.77]*	66.7	0.37
Post-pyloric feeding	0.49 [0.20; 0.78]*	74.3	0.74
Enteral nutrition withholding prior to extubation	0.00 [− 0.0004; 0.0004]	97.2	0.32
Duration of enteral nutrition withholding prior to extubation	0.66 [0.39; 0.93]*	85.7	0.65
Enteral nutrition withholding prior to transport	− 0.01 [− 0.31; 0.29]	55.6	0.13
Enteral nutrition withholding while neuro-blocking agent use	0.38 [0.11; 0.65]*	65.7	0.04	Nurses answer « yes » more often
Enteral nutrition withholding while prone positioning	0.34 [0.03; 0.65]*	79.4	0.28
Enteral nutrition withholding while hemodynamic instability	0.26 [0.05; 0.46]*	51.4	0.04	Physicians answer “withholding if hemodynamic instability” more often
Use of industrial 3-chamber parenteral nutrition bags	0.12 [− 0.26; 0.50]	79.4	0.26
Use of standardized parenteral nutrition bags	0.60 [0.33; 0.87]*	83.3	0.01	Nurses answer « yes » more often
Use of Y-infusion of different parenteral nutrient solutions	0.48 [0.22; 0.75]*	73.5	0.02	Nurses answer « yes » more often
Micronutrient supplementation	0.35 [− 0.05; 0.75]	68.7	0.81
Use of individualized compounded parenteral nutrition bags	0.12 [− 0.10; 0.34]	50.0	0.03	Nurses answer « yes » more often
Pre-op fasting practices	− 0.08 [− 0.33; 0.18]	36.1	0.19
Post-op fasting practices	0.19 [− 0.12; 0.50]	58.8	0.11

Agreement is poor (< 0.0), slight (0.00–0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80) or almost perfect (0.80–1.00)
Landis and Koch [11]
Data in italics correspond to discordant responses between physicians and nurses (p < 0.05)
^*Cohen’s kappa is significantly different from 0 when the confidence interval (IC95%) do not contain 0. Agreement between raters is significantly greater than chance agreement
^aCohen’s kappa measures the agreement between two raters beyond chance agreement
^bp value for MacNemar test < 0.05: discordant answers between nurses and physicians are not balanced

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