Malnutrition among Hospitalized Children in the United States: Changing Prevalence, Clinical Correlates, and Practice
Insights
Pediatric malnutrition diagnoses increased significantly from 2002 to 2011, impacting patient outcomes and healthcare costs. This highlights the need for better diagnostic tools beyond current coding systems.
Area of Science:
- Pediatric Health
- Clinical Nutrition
- Health Services Research
Background:
- Pediatric malnutrition is linked to poor clinical outcomes, extended hospital stays, and elevated healthcare expenses.
- Accurate identification of malnutrition is crucial for effective patient management and resource allocation.
Purpose of the Study:
- To analyze the prevalence, trends, and clinical outcomes of coded pediatric malnutrition (CDM) from 2002 to 2011.
- To examine variations in CDM across demographic, clinical, and hospital factors.
- To compare clinical outcomes among different malnutrition subtypes.
Main Methods:
- Retrospective analysis of nationally representative data from the Nationwide Inpatient Sample and Kids' Inpatient Database (2002-2011).
- Identification of pediatric malnutrition using International Classification of Diseases-9th Revision-Clinical Modification codes.
- Statistical analyses included logistic regression for associations and joinpoint regression for temporal trends.
Main Results:
- The national prevalence of coded pediatric malnutrition (CDM) was 2.6%, affecting over 54,600 of 2.1 million annual pediatric hospitalizations.
- CDM prevalence increased from 1.9% in 2002 to 3.7% in 2011 (8% annual increase), with variations across primary diagnoses.
- Patients with CDM experienced worse outcomes, longer hospital stays, and higher costs.
Conclusions:
- Pediatric malnutrition is underdiagnosed in inpatient settings using current ICD-based codes.
- There is a critical need for a national benchmarking program to accurately assess the true prevalence, impact, and cost of pediatric malnutrition.
Background:
Pediatric malnutrition has been associated with adverse clinical outcomes, longer lengths of stay, and higher health care costs.
Objective:
To characterize prevalence, temporal trends, and short-term clinical outcomes of coded diagnoses of pediatric malnutrition (CDM) across sociodemographic, clinical, and hospital characteristics from 2002 to 2011.
Design:
This study is a retrospective cross-sectional analysis of nationally representative data from the Nationwide Inpatient Sample and the Kids' Inpatient Database.
Participants/Setting:
The study sample included pediatric inpatient hospitalizations in the United States.
Main Outcome Measures:
International Classification of Diseases-9th Revision-Clinical Modification diagnosis codes were used to identify CDM and coded malnutrition subtypes based on an etiology-related definition of pediatric malnutrition.
Statistical Analyses:
The national frequency and prevalence of CDM overall and across patient- and hospital-level characteristics were estimated for children aged 1 month to 17 years. Logistic regression was used to assess the association between CDM and each characteristic. Analyses evaluated conditions associated with the highest burden and risk of CDM, and compared clinical outcomes across malnutrition subtypes. Joinpoint regression was used to describe temporal trends in CDM.
Results:
Of the 2.1 million pediatric patients hospitalized annually, more than 54,600 had CDM, a national prevalence of 2.6%. Considerable variation was observed based on primary diagnosis, with fluid and electrolyte disorders contributing the most malnutrition cases. Highest CDM rates were among patients with stomach cancer, cystic fibrosis, and human immunodeficiency virus. Patients with CDM experienced worse clinical outcomes, longer lengths of stay, and increased costs of inpatient care. The overall prevalence of CDM increased from 1.9% in 2002 to 3.7% in 2011, an 8% annual increase, and temporal increases were observed in nearly all population subgroups.
Conclusions:
Despite improvements, pediatric malnutrition remains underdiagnosed in inpatient settings when relying exclusively on International Classification of Diseases-based codes, which underscores the need for a national benchmarking program to estimate the true prevalence, clinical significance, and cost of pediatric malnutrition.
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