Malnutrition among Hospitalized Children in the United States: A 2012-2019 Update of Annual Trends
Jenni Carvalho-Salemi1, Wendy Phillips2, Molly Wong Vega3
1SAGE Research Group, Lutz, Florida.
Insights
Pediatric malnutrition diagnoses in US hospitals increased from 3.9% to 6.4% between 2012 and 2019. This study highlights improved diagnosis rates but stresses the need for ongoing education to address underdiagnosis.
Area of Science:
- Pediatric Health
- Clinical Informatics
- Nutritional Science
Background:
- Malnutrition in hospitalized children is linked to poor outcomes and high healthcare use.
- Pediatric malnutrition is frequently underdiagnosed, with limited national prevalence data.
- Improved recognition and standardized diagnosis are crucial for this vulnerable population.
Purpose of the Study:
- To evaluate changes in the coded diagnosis of malnutrition (CDM) among hospitalized children in the U.S.
- To assess trends in pediatric malnutrition diagnosis following increased awareness and standardization efforts.
Main Methods:
- Retrospective, cross-sectional analysis of nationally representative data from the Nationwide Inpatient Sample (NIS).
- Included 13.2 million hospitalizations for pediatric patients (1 month to 17 years) from 2012 to 2019.
- Utilized International Classification of Diseases (ICD) codes for malnutrition diagnosis and joinpoint regression for trend analysis.
Main Results:
- Coded diagnosis of malnutrition prevalence rose from 3.9% in 2012 to 6.4% in 2019.
- Failure to thrive diagnoses decreased, while protein-calorie malnutrition and multiple malnutrition subtype diagnoses increased.
- Significant variations in malnutrition diagnoses were observed across hospital types, race/ethnicity, and patient age.
Conclusions:
- While pediatric malnutrition diagnosis has improved, it remains underdiagnosed in hospital settings.
- Continued professional education is essential to enhance healthcare provider knowledge and diagnostic self-efficacy, particularly in non-teaching hospitals.
Background:
Malnutrition is associated with adverse clinical outcomes and increased health care utilization for hospitalized children. Yet pediatric malnutrition often goes undiagnosed and national prevalence research in this population is scarce.
Objective:
The aim was to assess change in the coded diagnosis of malnutrition (CDM) among US hospitalized children given increased awareness of the need for improved recognition and standardized diagnosis.
Design:
Retrospective, cross-sectional analysis using nationally representative data from the Nationwide Inpatient Sample.
Participants/Setting:
Our sample was 13.2 million hospitalizations from 2012 to 2019 among pediatric patients between age 1 month and 17 years.
Main Outcome Measure:
CDM using International Classification of Diseases Ninth and 10th Revision-Clinical Modification diagnosis codes.
Statistical Analyses:
Descriptive statistics and sampling weights were used to estimate the national frequency and prevalence of CDM. Temporal trends in CDM overall and stratified by age, race/ethnicity, and hospital type were analyzed using joinpoint regression.
Results:
CDM prevalence increased from 3.9% in 2012 to 6.4% in 2019. During this period, failure to thrive decreased from 40.6% to 23.3% of all cases with concomitant increases in the diagnosis of protein-calorie malnutrition and children identified with more than one malnutrition subtype. Differences in CDM diagnoses are evident by hospital type, race/ethnicity, and age of the patient.
Conclusions:
Although pediatric malnutrition continues to be underdiagnosed in hospital settings, this study demonstrates improvement over time. There continues to be a need for continued professional education regarding best practices for diagnosis to improve health care provider knowledge and self-efficacy on this topic, especially in nonteaching hospitals.
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