Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers

Area of Science:

• Pediatric Endocrinology
• Public Health
• Clinical Informatics

Background:

• Severe obesity prevalence in children has doubled over the last decade.
• Early identification and documentation of pediatric obesity are crucial for timely intervention.
• Existing guidelines for obesity management in children have not fully translated into consistent clinical documentation.

Purpose of the Study:

• To assess the clinical documentation rates of severe early onset obesity in young children.
• To identify factors influencing obesity documentation in pediatric healthcare settings.
• To evaluate the consistency of obesity documentation across different institutions and patient demographics.

Main Methods:

• Utilized a standardized algorithm on electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile, age <6 years).
• Extracted descriptive terms and ICD-9 codes from 9887 visit records of 2588 children across two tertiary pediatric hospitals (2007-2014).
• Analyzed documentation rates based on age at first visit, gender, race, and clinical setting (primary care, specialty clinics).

Main Results:

• Only 21.5% of children (13.5% of visits) had positive documentation of severe early onset obesity.
• Documentation rates were lower in children first seen under 2 years (15%) compared to older children (26%).
• Higher documentation rates were observed in girls (29%), African American children (27%), and obesity-focused specialty clinics (70%) versus primary care (15%).

Conclusions:

• Significant opportunities exist to improve the clinical documentation of severe early onset obesity in young children.
• Documentation consistency varies by patient demographics and clinical setting, indicating potential disparities in care.
• Enhanced documentation practices are needed to align with established pediatric obesity management guidelines.