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In this paper, an adaptation of the system-theoretic process analysis (STPA) approach to a sociotechnical system of monitoring and tracking diabetes mellitus (DM) is proposed. Several human controllers such as the patient, physicians, other healthcare providers, and people in the social environment were considered in the hierarchical safety control structure. During the identification of the causal factors (causal scenarios) for the unsafe control actions of the human controllers, the three-phase approach proposed by France (2017) as well as the interaction problems between the subsystems in the hierarchical safety control structure were considered, and the implementation of the basic safety design procedure was included in the methodology for the improvement of system. A dynamic STPA methodology is also proposed as an extension to the basic methodology., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: There is a need for an ecological and complex systems approach for better understanding the development and prevention of running-related injury (RRI). In a previous article, we proposed a prototype model of the Australian recreational distance running system which was based on the Systems Theoretic Accident Mapping and Processes (STAMP) method. That model included the influence of political, organisational, managerial, and sociocultural determinants alongside individual-level factors in relation to RRI development. The purpose of this study was to validate that prototype model by drawing on the expertise of both systems thinking and distance running experts., Materials and Methods: This study used a modified Delphi technique involving a series of online surveys (December 2016- March 2017). The initial survey was divided into four sections containing a total of seven questions pertaining to different features associated with the prototype model. Consensus in opinion about the validity of the prototype model was reached when the number of experts who agreed or disagreed with survey statement was ≥75% of the total number of respondents., Results: A total of two Delphi rounds was needed to validate the prototype model. Out of a total of 51 experts who were initially contacted, 50.9% (n = 26) completed the first round of the Delphi, and 92.3% (n = 24) of those in the first round participated in the second. Most of the 24 full participants considered themselves to be a running expert (66.7%), and approximately a third indicated their expertise as a systems thinker (33.3%). After the second round, 91.7% of the experts agreed that the prototype model was a valid description of the Australian distance running system., Conclusion: This is the first study to formally examine the development and prevention of RRI from an ecological and complex systems perspective. The validated model of the Australian distance running system facilitates theoretical advancement in terms of identifying practical system-wide opportunities for the implementation of sustainable RRI prevention interventions. This 'big picture' perspective represents the first step required when thinking about the range of contributory causal factors that affect other system elements, as well as runners' behaviours in relation to RRI risk., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background This study examines spinal muscular atrophy (SMA), a neuromuscular disease associated with malnutrition. Our goals are to assess how effectively screening tools can detect malnutrition and evaluate the impact of nutritional interventions on neurological outcomes, particularly motor functions. Methods Thirty-seven genetically diagnosed SMA patients (types 1, 2, and 3) under nusinersen therapy were included in the study. The nutritional status of these patients was assessed by using anthropometric measurements, including height for age (HFA), weight for height (WFH), and body mass index (BMI) before and after the study. Additionally, the risk of malnutrition was determined using screening tools, namely the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP). Nutritional counseling followed the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines and considered the patients' dietary history, including content and administration method. Motor functions were assessed by validated tests: the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) and the Hammersmith Functional Motor Scale—Expanded (HFMSE). Result The study showed an improvement in HFA, by a change from −0.95 to −0.65 (p = 0.015). Conversely, BMI scores decreased from 0.08 to −0.54 (p = 0.015), while WFH and MUAC showed no significant alterations (p = 0.135, p = 0.307). Following nutritional interventions, HFMSE demonstrated a median increase from 29.5 to 30.5 (p = 0.023). Patients identified as being at high risk for malnutrition based on PYMS and STAMP belonged to the moderate-to-severe malnutrition group (BMI Z-score ≤ −2, p = 0.001). Conclusions Use of screening tools in SMA patients is highly beneficial for the early detection of malnutrition. Future research should highlight the importance of combining nutritional management with nusinersen therapy to potentially alter the disease trajectory, especially in motor and neurological functions. [ABSTRACT FROM AUTHOR]

Road transport is experiencing disruptive change from new first-of-a-kind technologies. While such technologies offer safety and operational benefits, they also pose new risks. It is critical to proactively identify risks during the design, development and testing of new technologies. The Systems Theoretic Accident Model and Processes (STAMP) method analyses the dynamic structure in place to manage safety risks. This study applied STAMP to develop a control structure model for emerging technologies in the Australian road transport system and identified control gaps. The control structure shows the actors responsible for managing risks associated with first-of-a-kind technologies and the existing control and feedback mechanisms. Gaps identified related to controls (e.g. legislation) and feedback mechanisms (e.g. monitoring for behavioural adaptation). The study provides an example of how STAMP can be used to identify control structure gaps requiring attention to support the safe introduction of new technologies. This paper considers emerging risks associated with new technologies in the road transport system. It demonstrates a novel approach using STAMP to identify gaps in control and feedback mechanisms within the existing control structure which should be addressed to mitigate risk. [ABSTRACT FROM AUTHOR]

In order to address the limitation and isolation of a single accident model for accident reporting research, this study integrates the advantages of the STAMP (System Theoretical Accident Modeling and Process) model and the HFACS (Human Factors Analysis and Classification System) model, and analyzed and studied 249 collapse accident case reports from 2012 to 2021. It identified 27 collapse accident risk factors, and developed a collapse accident network. This study used core-edge analysis and centrality analysis to identify key risk factors such as failure to strictly implement the safety production responsibility system, inadequate review of relevant qualifications, inadequate on-site management, and dereliction of duty in on-site supervision. Finally, the correlation direction index was used to excavate the cause-result characteristics of each risk factor. [ABSTRACT FROM AUTHOR]

The existing security risk assessment methods and models do not fully consider the impact of the risk assessment behavior itself on the assessment results, which is a big lack of understanding that the behavior of risk assessment may introduce security risk. In response to this problem, this paper first establishes a complete STAMP model of risk assessment behavior. On this basis, the STPA analysis method is used to conduct security analysis on risk assessment behavior, the STAMP theory is used to construct a risk assessment behavior security index system, and the improved AHP method is used to screen important index factors in the security index system. The proposed security index system focuses on the emergence of the system as a whole rather than the reliability of individual components. According to the reasons for the occurrence or danger of system safety accidents, it provides a more effective way of constructing a safety index system. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a determining factor of pediatric mortality and morbidity, especially in low and middle-income countries. Hospitalized children are at a higher risk of malnutrition. Several malnutrition screening tools have been used, among which STAMP, PYMS, and STRONGkids are valid tools with high sensitivity and specificity. The aim of this study was to compare these screening tools to find the best ones in identifying the risk of malnutrition in hospitalized children. Methods: This is a cross-sectional study performed on hospitalized children aged 1 to 16 years. The questionnaires of PYMS, STAMP, STRONGkids malnutrition risk assessment tools were filled. The weight for height and BMI for age Z-scores were calculated. The data were analyzed by SPSS. Sensitivity, specificity, positive predictive value, and negative predictive values of the risk scores based on weight for height and BMI for age Z-scores were calculated. Results: Ninety-three patients with a mean age of 5.53 ± 3.9 years were included. The frequency of malnutrition was reported as 26% and 39% according to weight for height and BMI for age Z-scores, respectively. A significant relationship was found between PYMS and Weight for height Z-score (P-value < 0.001), and BMI for age Z-score (P-value < 0.001). Moreover, STRONGkids was found to be associated with weight for height Z-score (P-value: 0.017). Conclusion: The PYMS is a practical and beneficial tool in early identifying the risk of severe malnutrition in hospitalized patients. It is a suitable method for patients in our settings. [ABSTRACT FROM AUTHOR]

• Use of STAMP for quantitative dynamic risk assessment. • Modeling systemic risk propagation and accumulation in complex systems. • Integrating STAMP and CFPM for risk assessment. To maintain continuous production, chemical plant operators may ignore faults or handle faults online rather than shutting down process systems. However, interaction and interdependence links between components in a digitalized process system are substantial. Thus, faults will be propagated to downstream nodes, potentially leading to risk accumulation and major accidents. However, limited attention has been paid to this type of risk. To model the risk accumulation process, a dynamic risk assessment method is proposed by integrating the system-theoretic accident model and process approach (STAMP) and the cascading failure propagation model (CFPM). Firstly, STAMP is used to model and analyze the system safety of a process system. Two CFPMs are then proposed to measure risk accumulation under two different engineering situations. The proposed method is applied to the Chevron Richmond refinery crude unit and its associated upstream process. The results show that the proposed approach can effectively quantify the process of risk accumulation. This method can generate a real-time dynamic risk profile to support auxiliary decision-making. [ABSTRACT FROM AUTHOR]

Highlights • Systems ergonomics methods are increasingly being used to optimise transport systems. • Integration of different methods potentially provides a richer more useful analysis. • The EAST analysis framework was modified to incorporate principles of STAMP. • The modified framework was used to analyse safety in Railway Level Crossing (RLX) systems. • The analysis revealed areas where RLX safety management practice could be enhanced. Abstract Various systems ergonomics methods are available to support the design and analysis of rail systems. Whilst the utility of these methods is accepted, the increasing complexity of modern day systems is stretching their capabilities. The integration of distinct systems ergonomics methods provides a means of redressing this. This article presents a study in which the underpinning principles of the STAMP control structure method were added to the EAST framework, and subsequently used to examine railway level crossing safety management. Task, social and information networks for a railway level crossing system lifecycle were developed along with an additional control network showing safety controls and their interrelations. Analysis of the networks points to a need to (1) strengthen activities and controls around proactive risk management and performance monitoring, (2) tighten the coupling between organisations responsible for safety management, and (3) to increase the flexibility of design standards. The implications for future railway level crossing safety management and rail safety research and practice are discussed. [ABSTRACT FROM AUTHOR]

• We propose the safety assessment of a transportable, plug-and-play, heat-pipe-cooled microreactor. • We make use of an advanced safety framework that embeds STPA, modeling and simulation, and GTST-MLD. • The work provides qualitative, quantitate, and dynamic risk insights. • The safety framework makes use of the RELAP code. • We identify previously unknown threats and hazards relevant to the novel microreactor design. A safety analysis of a transportable, plug-and-play, heat-pipe-cooled microreactor – or Nuclear Battery (NB)– designed at MIT is presented. The considered design is a semi-autonomous 5 MW (thermal) high-temperature heat-pipe-cooled, yttrium-hydride moderated NB envisioned to be a transportable, flexible, affordable, and distributed low-carbon energy source. The analysis makes use of a recently proposed methodology that integrates i) System-Theoretic Accident Model and Processes (STAMP) to guide a qualitative exploration of the NB threats and hazards, ii) Modeling and Simulation (M&S) to investigate the NB dynamic behavior during accident scenarios, and iii) Goal-Tree Success-Tree Master Logic Diagram (GTST-MLD) to assess risk quantitatively. The methodology has been shown to provide systematic risk insights without the need to rely on prior operating experience, and enables a dynamic evaluation of the risk profile. Moreover, it identifies unknown threats and hazards relevant to the novel microreactor design and explores the related accident scenarios. The key findings of the safety analysis performed on the nuclear microreactor considered are the identification of vulnerabilities related to the use of yttrium hydride as the moderator, the assessment of threats and accident scenarios associated with the loss of sodium from the heat pipes, and, for such scenarios, the quantification of the grace time, i.e., the period during which human operators can intervene to avoid unacceptable consequences. [ABSTRACT FROM AUTHOR]

Several approaches to systems thinking have been proposed to understand and model complex socio-technical systems and potential accidents, including the System-Theoretic Accident Model and Processes (STAMP) with the associated hazard analysis method System Theoretic Process Analysis (STPA), and the Functional Resonance Analysis Method (FRAM). It is argued that these approaches are suitable for the risk analysis of complex socio-technical systems. The purpose of this paper is to look more closely into this thesis, with a special focus on the treatment of uncertainty and potential surprises linked to the operation of such systems. A key finding is that these approaches may, indeed, reduce the potential for surprises by increasing the system and risk understanding but need to be supplemented with other approaches to adequately support the decision-making on risk issues. [ABSTRACT FROM AUTHOR]

• We propose a novel methodology for dynamic risk assessment. • The methodology integrates STAMP, modeling and simulation, and GTST-MLD. • The methodology provides qualitative, quantitate, and dynamic risk insights. • The methodology makes use of RELAP code. • The methodology is validated considering the safety assessment of a micro-reactor. Accidents may occur as a result of complex dynamic processes in interconnected socio-technical systems. Such accidents cannot be explained solely in terms of static chains of failures. Therefore, the traditional Probabilistic Risk Assessment (PRA) framework, which stands on the consideration that accidents are caused by direct failures or chains of events, is not apt to describe the dynamic behavior of the relevant Systems, Structures and Components (SSCs) and assess the risk. This work proposes a novel framework that embeds (i) System-Theoretic Accident Model and Processes (STAMP) principles to guide a qualitative exploration of the SSC threats and hazards, (ii) Modeling and Simulation (M&S) to investigate the SSC dynamic behavior during accidental scenarios, and (iii) the Goal-Tree Success-Tree Master Logic Diagram (GTST-MLD) framework to assess risk quantitatively. The integration of STAMP, M&S and GTST-MLD allows a systematic analysis to provide risk insights, with due account to the SSC dependencies and interactions, and enables a dynamic assessment of the risk profile. The effectiveness of the proposed framework is shown by means of its application to the safety assessment of Nuclear Batteries (NBs), a unique class of nuclear micro-reactors which is gaining attention as a transportable, flexible, affordable, and distributed low-carbon power source. [ABSTRACT FROM AUTHOR]

The world of the energy & chemicals industry has been slow to adopt systems theoretic approaches. The focus of this paper is a summary of the present state of the industry in terms of technical design HSE practice – the world of process safety. This will then be followed by some consideration of the barriers to adoption of more rigorous systems theoretic type approaches, and the prospects for introduction of systems theoretical techniques in large capital projects within the above industries. [ABSTRACT FROM AUTHOR]

This paper presents a STAMP-based indicator of measuring the inherent, in terms of the system design and development, capability of each system part to provide its agent with Situation Awareness (SA) about the presence of system threats and vulnerabilities that may lead to accidents. An agent is a human or automated controller that possesses reasoning mechanisms and demonstrates a capability to influence others or modify situations. This capability – in as far as it pertains to risk modification - is called “ risk SA provision capability ” (RiskSOAP) and can be modelled in a control loop. This capability is considered as dynamic because it can fluctuate over time due to changes in safety specifications and short- or long-term conditions. In order to demonstrate the fluctuation of the risk SA provision capability along the development of an accident, the STAMP-based RiskSOAP indicator is calculated throughout the Überlingen accident timeline. This timeline incorporates four milestones, each one denoting a particular time point in the accident development. The decline in the value of the RiskSOAP indicator is attributed to the presence of flaws and unsafe control actions, through which accident scenarios are verified and the system is headed for an accident. The main conclusion is that in such socio-technical systems there is a tight coupling between the degradation of the risk SA provision capability and the degradation of safety. [ABSTRACT FROM AUTHOR]

The integration of Remotely Piloted Aircraft Systems (RPAS) in today's society depends on the ability of their operators to demonstrate safety. RPAS operators use risk matrices, as required by the Dutch government, to indicate the safety level. Key issues with this approach include the lack of available component reliability data for determining the risk factors, and the exclusion of human interactions. This study aims to determine the competence of the Systematic Theoretic Process Analysis (STPA) to demonstrate the safety of RPAS operations. It is concluded that the STPA is a comprehensive method to demonstrate the safety of RPAS operations. [ABSTRACT FROM AUTHOR]

STAMP postulates that accidents result from inadequate enforcement of system safety constraints in design, development and operations. It claims that Causal Analysis based on STAMP (CAST) is needed to ensure understanding of the entire accident process and all systemic causal factors involved. STAMP does not specify an accident investigation process. CAST uses information about accidental occurrences in its analyses application, including information, disseminated through investigation reports. When CAST analysts consider an accidental occurrence report as a candidate for analysis, they should be aware of the variations among investigation reports and how they might affect their analysis. They are unlikely to recognize them unless they have conducted and reported actual investigations using more than one method. This paper examines the information CAST requires and its sources, what that various safety investigations now provide, the variances in that information, other sources of input data CAST needs, and describes issues found. Changing investigation reports and methods however is necessary, but insufficient. It requires a non-Tayloristic view on human error and mobilizes other data sources of a systemic nature such as design history, network typologies and business models. [ABSTRACT FROM AUTHOR]

We evaluated tool qualification requirements for hazard and risk analysis software tools, particularly for tools supporting System-Theoretic Process Analysis (STPA), and compared the tool qualification approaches of safety standards IEC 61508, EN 50128, DO-178C/DO-330 and ISO 26262. Our software tool SAHRA integrates STPA in an existing engineering toolchain by providing an extension for the UML/SysML modeling tool Sparx Systems Enterprise Architect. We found that the qualification of this tool according to the mentioned safety standards was not straightforward and required further analysis. Therefore, we analyzed the tool risks and found that those depend on many factors such as process risks, risks from tool errors, tool integration risks and operational scenarios regarding the use of the tool in the development lifecycle. We selected four operational scenarios for tools supporting STPA to evaluate tool qualification requirements. After concluding that a tool qualification is required, we used a multi-domain tool qualification development lifecycle guided by DO-330 for SAHRA. [ABSTRACT FROM AUTHOR]

System thinking concepts and simulation tools are used to model the risk prevention plan and operational modes designed to enforce safety constraints at a French liquefied petroleum gas (LPG) storage and distribution facility. In France, such facilities are classified and the subject of special legislation and safety regulations. Their supervision is the responsibility of a control and regulatory body. A technological risk and prevention plan is provided, where all the dangerous phenomena likely to occur in addition to the safety control measures are listed in the safety report. Safety is therefore addressed through rules, and control mechanisms ensure that the system complies with safety constraints. Taking this facility as a case study, we use the STAMP theoretical framework together with AnyLogic simulation software to model technical elements and human and organizational behavior. We simulate how the system evolves over time and the strategies that are deployed in a loss of control scenario. The aim is to assess whether the prescribed safety program covers all of the system's phases; namely operations and audits. The results enrich other research that focuses on the contribution of system dynamics to risk analysis and accident prevention. [ABSTRACT FROM AUTHOR]

The goal of leading indicators for safety is to identify the potential for an accident before it occurs. Past efforts have focused on identifying general leading indicators, such as maintenance backlog, that apply widely in an industry or even across industries. Other recommendations produce more system-specific leading indicators, but start from system hazard analysis and thus are limited by the causes considered by the traditional hazard analysis techniques. Most rely on quantitative metrics, often based on probabilistic risk assessments. This paper describes a new and different approach to identifying system-specific leading indicators and provides guidance in designing a risk management structure to generate, monitor and use the results. The approach is based on the STAMP (System-Theoretic Accident Model and Processes) model of accident causation and tools that have been designed to build on that model. STAMP extends current accident causality to include more complex causes than simply component failures and chains of failure events or deviations from operational expectations. It incorporates basic principles of systems thinking and is based on systems theory rather than traditional reliability theory. [ABSTRACT FROM AUTHOR]

Blowout preventer (BOP) plays a key role in preventing blowout accidents from occurring during offshore or deepwater drilling. The safety of BOP is affected by diverse components and interactions among them. It is vital to identify the crucial failure modes using safety assessment method. To perform a qualitative, quantitative, and systematic safety assessment of BOP, this paper presents an integrated method—using the system-theoretic accident model and process (STAMP)-Bayesian network (BN)—for evaluation of the structure safety and prediction of the failure scenarios. In the proposed method, STAMP is used to identify the failure scenarios by establishing a hierarchical control and feedback model that tallies with the BOP structure, while BN is adopted to calculate the probabilities of potential failure modes based on the outcomes of STAMP. The approach is then explored in a case study where factors regarding humans, components and control systems, and constraints and control relationships among them are all considered. The results demonstrate the feasibility of the integrated method as a way of performing a safety analysis for BOP. This research overcomes the deficiencies of traditional methods that cannot effectively evaluate the interactions of components, thereby providing a reference for safety/risk analyses of complex systems. • A new framework for safety modeling of subsea blowout preventer is proposed. • A hierarchical control and feedback structure of BOP is established based on STAMP. • An approach for constructing BNs from STAMP model is proposed. • The framework provides a reference for safety assessment of other complex systems. [ABSTRACT FROM AUTHOR]

• A framework to model a hierarchical control structure for the STPA analysis of an autonomous ship is presented. • STAMP, STPA and STECA were used as the foundation of the proposed framework. • The framework makes use of the available knowledge of current shipping operation and seafarers experience. • The resulting control structure of shipping operation includes the autonomous ship and the Shore-based Control Centre as controlled processes. • The application to the Autonomous Navigation System reveals substantial information for the safety of autonomous ships. The demand for risk and safety analysis is becoming greater due to the increased complexity of modern systems such as autonomous ships. Safety is one of the main motivations behind the efforts of multiple organizations to develop autonomous ships. The adoption of an early system-theoretic approach to safety such as System Theoretic Process Analysis (STPA) is an effective way to integrate safety in complex systems. Furthermore, many authors have urged the use of this method to analyse the risks of autonomous vessels in the development phases. Applying STPA requires a description of the system to model the hierarchical control structure and conduct the analysis. At this stage, the functional description of autonomous ships remains limited, which poses a challenge in building the hierarchical control structure. This paper proposes a framework for developing a hierarchical control structure of an autonomous ship. The framework is founded on the principles of the STPA control structure and its five main elements. It makes use of the current shipping operation system, the available information about autonomous ships and the experience of seafarers executing diverse tasks on-board conventional ships. The application of the framework showed that the information provided by the seafarers is essential in developing an initial functional description of an autonomous ship. Furthermore, the results revealed that in addition to the technical aspects of autonomous ships, introducing these vessels into the organizational control structure of current maritime operation also poses challenges that need to be addressed in the earliest design phase. [ABSTRACT FROM AUTHOR]

• In ultra-safe systems, gradual deterioration of information creates safety issue. • Excessive reliance on "Learning from the past" may also lead to accidents. • The regulatory safety protection may become ineffective for self-regulated systems. • System-thinking based risk-assessment by both operator and regulator is necessary. • Leading indicators for organizational components should help improve system-safety. The Japanese High-Speed Railway (HSR), is renowned for its impeccable safety record of zero passenger fatalities. However, a limited academic discussion has taken place on the organizational and institutional factors affecting HSR safety in Japan, as opposed to technological solutions. A recent series of HSR accidents in Japan have also warranted attention on organizational and institutional factors affecting HSR safety. The objective of the present study is to utilize systems approach to highlight the current organizational and institutional safety issues within Japanese HSR, and to provide a discussion on improving current practices. First, the study develops a taxonomy of accident causes in Japanese HSR, using previously unanalyzed official accident reports available only in Japanese. The taxonomy analysis reveals common accident causal factors, including the failure to sense degradation in procedures, and the failure to establish knowledge-based on thorough risk assessments. The paper then presents an in-depth analysis of the only "Serious Accident" in Japanese HSR. Information on the serious accident obtained through official accident reports and expert interviews is combined using a System-Theoretic Accident Model and Process (STAMP) analysis, which reveal a new accident archetype at the organizational and institutional level. The archetype demonstrates the common failure causes for the operator and the regulator, thereby making their apparent redundancy ineffective. The archetype is helpful in identifying theoretical improvements in current safety practices. The study also concludes that the adoption of a systematic risk-assessment approach is necessary to enable proactive safety management in complex ultra-safe systems like the Japanese HSR. [ABSTRACT FROM AUTHOR]

Aim: to evaluate validity and concordance of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) and Screening Tool for Risk On Nutritional status and Growth (STRONGkids) screening tools for assessment of nutritional risk in pediatric inpatients. Methods: Prospective longitudinal observational multicenter study in children aged 1 month or older admitted as inpatients. Weight, height, cause of admission, demographic data, length of stay, and nutritional interventions were recorded. STAMP and STRONGkids were applied within the first 72 h of admission. Anthropometric measurements were recorded again 12–18 months after admission. Results: Eighty-one patients with median age of 4.1 years completed the study. Agreement between tools was moderate (κ = 0.47). STAMP had a greater tendency to classify patients as high risk (12.3% vs. 2.5%). Both tools showed very weak correlation with height for age. All undernourished patients at the beginning and the end of the study were classified as medium or high risk by STAMP and STRONGkids (100% sensitivity), although specificity was below 50% in all cases. There were no differences in length of stay based on nutritional risk with any of the tools. Conclusions: STAMP and STRONGkids demonstrated moderate agreement, with high sensitivity but low specificity for the diagnosis of undernutrition. Further studies are required to analyze cost-effectiveness of these tools and nutritional interventions derived from them. [ABSTRACT FROM AUTHOR]