Argon and Subarachnoid Hemorrhage.

e1008 www.ccmjournal. org October 2016 • Volume 44 • Number 10 assessment, recent growth history, physical examination, and other markers. Unfortunately, these methods require significant resources and time that are often limited. Furthermore, composite screening tools that incorporate some of these elements are available for hospitalized children, but their clinical application has recently been questioned and they have not been validated in the PICU population (2). The limitations of BMI are well known. Weight and height measurements remain challenging to obtain due to fluid shifts and critical illness in some patients in the PICU. Despite these challenges, anthropometric assessments are now widely recognized as an important part of admission procedures and help guide nutritional, fluid, ventilator, and pharmaceutical prescriptions. In centers with nutrition champions and adequate training, these measurements can be successfully and reliably obtained in a majority of patients in the PICU (3). Higher BMI has been shown to be a risk factor for poorer survival in pediatric leukemia (4). Our results support the use of BMI as a simple screening tool in the PICU population to detect at-risk patients who should be targeted for a more in-depth nutritional assessment. We do not propose that it should replace a detailed nutritional assessment at admission and during the PICU stay. The prospective study design allowed a high proportion of the recruited patients to have measured weights and heights at admission. No data were imputed as incorrectly suggested by Colombo et al (1) in their letter. For 9% of weight measurements and 28% of height measurements, bedside providers at participating sites recorded their best estimate for values when measurements were not feasible at admission. Estimating weight and height in a small fraction of patients in the PICU, especially in a cohort of mechanically ventilated patients with high severity of illness, is not uncommon practice in the PICU. Although we acknowledge the potential imprecision of these estimates, these values were clinically informed. To confirm the associations with outcomes, we repeated the analysis in the 67% of the cohort (n = 1,093) with measured weight and height, and found similar results to those presented in the article. We acknowledge that BMI z scores are derived from healthy populations. The z score is the recommended statistic for interpretation of anthropometry measurements for appropriate comparison between the subject and the reference value. Anthropometric measurements are just one component of a nutritional assessment, and individualized evaluations of all available patient data are needed to inform feeding decisions. Our results emphasize the importance of nutritional assessments, address anthropometry that is often ignored, and provide a simple and feasible screen that can be applied at admission in a majority of the patients in the PICU. Dr. Bechard received funding from Nestle Nutrition. Her institution received funding from Academy of nutrition and dietetics. Dr. Mehta has disclosed that he does not have any potential conflicts of interest.