Int J Adolesc Med Health 2015; 27(1): 49–56
Albert C. Hergenroeder*, Constance M. Wiemann, Christopher Henges and Amanda Dave
Outcome of adolescents with eating disorders from an adolescent medicine service at a large children’s hospital Abstract Objective: To describe outcomes of adolescents with eating disorders treated by an interdisciplinary adolescent medicine service at a large children’s hospital and to identify factors, including hospitalization, associated with outcome. Design: The study design was a retrospective chart review of patients. Setting: The setting was an inpatient and outpatient adolescent service in a large urban children’s hospital. Participants: A total of 218 adolescents diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified participated in the study. Intervention: Interdisciplinary inpatient and outpatient treatment for eating disorders was adopted for intervention. Outcome measures: Patient outcomes were categorized as fully recovered, partially recovered/improved, or poorly recovered/exhibiting chronicity. Results: Being admitted to the study hospital once and longer duration of follow-up were associated with full or partial recovery. In contrast, being readmitted to the study hospital and longer duration of illness prior to the initial contact with this service were associated with poor recovery. Premorbid obesity was unrelated to outcome. Conclusions: Earlier detection and referral of adolescents with eating disorders are needed because a high percentage of patients, especially those with anorexia nervosa, required hospitalization at initial contact. The benefits of inpatient admission may extend beyond medical stabilization of the most medically compromised patients to include improved therapeutic relationship with the treatment team and improved follow-up. Many patients prematurely terminate treatment; factors contributing *Corresponding author: Albert C. Hergenroeder, MD, 6701 Fannin Street, Suite 1710, Houston, TX 77030, USA, Phone: +1-832-8223658, Fax: +1-832-8253689, E-mail: [email protected]
Constance M. Wiemann, Christopher Henges and Amanda Dave: Baylor College of Medicine, Houston, TX, USA
to premature termination of therapy need further exploration. Keywords: anorexia nervosa; bulimia nervosa; eating disorder outcomes. DOI 10.1515/ijamh-2013-0341 Received December 19, 2013; accepted April 17, 2014; previously published online May 31, 2014
Background In the USA, an estimated 7% and 14% of 9- and 14-yearold males and females, respectively, experience anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) (1). Furthermore, 20%–30% of patients with AN or BN do not recover completely from their illness, as evidenced by significant medical sequelae (2–9). AN has a crude mortality rate of 1.8%–9.8% (5, 10–15). The crude mortality rate for patients with BN followed for at least 6 months has been reported to be 0.3% (5). For decades, experts have recognized the lack of consensus for the best treatment for adolescents with eating disorders (3). Some patients require medical hospitalization, yet considerable variability exists regarding hospital admission criteria (13, 16). Once admitted, the complexity and duration of inpatient care are variable, ranging from an adolescent medicine unit specializing in eating disorders utilizing an interdisciplinary (mental health, medical, nursing, and nutrition) team approach, averaging 7 weeks of treatment (17) to no specific milieu for the treatment of eating disorders, averaging a stay of a few days (18). Some patients may be transferred to an inpatient psychiatric eating disorders program, which has been associated with poorer outcomes (19, 20). Not all patients need inpatient treatment (13). Given the morbidity and mortality, the lack of consensus about and heterogeneity of treatment for patients with medical compromise, the evidence in favor of earlier treatment and weight restoration, and pressure from insurance companies to discharge patients from inpatient to outpatient care before adequate weight restoration occurs, there is a need
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50 Hergenroeder et al.: Outcome of adolescents with eating disorders for programs to report the specifics of their patient population, treatment programs, and outcomes (21–24). The purpose of this study was to describe outcomes of adolescents with eating disorders who presented over a 5-year period for treatment by an interdisciplinary adolescent medicine team at a large children’s hospital, and to identify factors associated with outcome. A specific goal was to examine the relationship between being admitted to the hospital and patient outcomes.
charts of the remaining 244 potential participants were then reviewed for demographic, physiologic, laboratory, and treatment data to identify the final study population. Potential participants with one outpatient visit or who were admitted to the hospital at initial contact and who did not follow-up after admission (n = 26) were excluded, leaving a final study population of 218. These 218 participants did not differ from the 244 potential participants in terms of mean age, weight, lowest pulse, orthostatic pulse change, percent eIBW at initial contact, the proportion of specific eating disorder diagnosed, premorbid obesity, and history of other psychiatric disease.
Inpatient treatment program
Methods Study design The study design was a retrospective chart review of patients ages 10–25 years diagnosed with an eating disorder and treated on an inpatient or outpatient basis by an interdisciplinary adolescent medicine team at a large urban hospital. Inclusion criteria were: having a diagnosis of AN, BN, or EDNOS; initial contact with the Adolescent Medicine Service between 1 January, 2004 and 31 December, 2008; and seen at least once in the study clinic after the initial contact. A total of 307 potentially eligible participants were found by reviewing the medical record of each patient seen for an initial visit in the Adolescent Clinic, an emergency center visit or admission to the Adolescent Medicine Service during the specified time frame, regardless of their reason for referral. Charts were examined for evidence of an eating disorder including the following diagnoses: weight loss, malnutrition [body weight