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Medical Assessment and Triage of Pediatric Patients with Anorexia Nervosa in Primary Care
Kendra J Homan1, Leslie A Sim1, Susan L Crowley2
1Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN. Dr. Homan is now with the Cincinnati Children's Hospital Medical Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Pediatric patients with anorexia nervosa (AN) often miss diagnoses and appropriate care in primary settings. Early, evidence-based triage in primary care significantly improves diagnosis and treatment timelines for AN.
Area of Science:
- Pediatric Medicine
- Eating Disorders
- Primary Care
Background:
- Anorexia nervosa (AN) is a serious eating disorder affecting pediatric populations.
- Early identification and intervention are crucial for favorable outcomes in pediatric AN.
- Primary care settings are often the first point of contact for children with potential eating disorders.
Purpose of the Study:
- To evaluate the medical assessment and triage of pediatric patients diagnosed with anorexia nervosa (AN) in primary care.
- To identify deviations from recommended practice guidelines in the initial management of pediatric AN in primary care.
- To explore the impact of appropriate triage on the timeliness of diagnosis and treatment.
Main Methods:
- Retrospective cohort study of pediatric patients with AN symptoms identified in primary care.
- Data abstracted from medical records between 2010 and 2016.
- Analysis of presenting concerns, medical assessments, laboratory tests, diagnoses, and treatment recommendations.
Main Results:
- Only 5% of pediatric AN patients received a diagnosis during their initial primary care visit.
- A minority of patients were assessed for critical complications like electrolyte disturbances or hypothermia.
- 56% received triage consistent with recommendations, but only 2 patients meeting inpatient criteria were hospitalized.
- Appropriate triage correlated with significantly earlier AN diagnosis and treatment.
Conclusions:
- Pediatric patients with AN may not receive adequate medical assessment and triage in primary care settings.
- Barriers to evidence-based care for pediatric eating disorders need to be understood.
- Improved provider education and system changes are necessary to enhance outcomes for pediatric AN patients.
Objective:
To examine the medical assessment and triage of pediatric patients with anorexia nervosa (AN) initially seen in primary care.
Methods:
A retrospective cohort study was conducted for all pediatric patients with AN who had eating/weight concerns and initially identified symptoms in primary care in a single health care system between January 1, 2010, and December 31, 2016. Information on presenting concern, medical assessment/laboratory tests, clinical diagnoses, treatment recommendations, and referrals were abstracted from the medical record.
Results:
Forty-one (mean age = 13.7 years; SD = 2.2) pediatric patients with AN had eating/weight concerns and initially identified symptoms in a primary care. Overall, only 5% (n = 2/41) of patients received an AN diagnosis during the index visit; a minority were assessed for electrolyte disturbance (n = 20), electrocardiogram abnormality (n = 18), hypothermia (n = 13), binge/purge behaviors (n = 13), orthostatic hypotension (n = 2), or dehydration (n = 1), and only 56% (n = 23) received triage consistent with practice recommendations. Although 61% (n = 25) met criteria for inpatient admission, inpatient hospitalization was recommended for only 2 patients. Patients who received triage consistent with practice recommendations received AN diagnosis and treatment significantly earlier than those who did not (p < 0.01 and p = 0.001, respectively).
Conclusion:
Findings suggest that pediatric patients with AN may not be receiving medical assessment and triage per practice recommendations in the primary care setting. Understanding barriers to evidence-based care for pediatric eating disorders may inform provider education and system-wide changes to enhance outcomes in these patients.
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