Division of Hospital Medicine, Department of Medicine, Boulder Community Hospital, Denver, Colorado, USA.
J Hosp Med. 2012 Apr;7(4):340-4. doi: 10.1002/jhm.1906. Epub 2012 Jan 23.
While patients with anorexia nervosa have a high mortality rate, more are living into adulthood. Patients with severe malnutrition secondary to anorexia nervosa often require hospitalization for medical stabilization prior to treatment in eating disorders programs.
We developed the ACUTE Center at Denver Health Medical Center to medically stabilize adults with the medical complications of severe malnutrition due to an eating disorder. The first 2 years of patient characteristics and outcomes are reported.
From October 2008 through December 2010, the ACUTE unit had 76 admissions of which 62 were for medical stabilization, comprising 54 patients. Eighty-nine percent of patients were female. The mean age was 27 years old (range 17-65). The mean body mass index on admission was 12.9 kg/m(2) (standard deviation [SD] 2.0). At admission, patients were hyponatremic, anemic, and leukopenic, with low bone density, but had normal albumin levels. The mean body mass index on discharge was 13.1 ± 1.9 kg/m(2). Median length of stay was 16 days (interquartile range [IQR] 9-29 days). Eighteen percent were discharged to home and eighty-two percent were discharged to inpatient psychiatric eating disorder units. Inpatient mortality was zero.
Patients with this degree of severe malnutrition due to eating disorders are medically complex and relatively uncommon. Regionalized subspecialty centers of excellence, in which a multidisciplinary team is led by practitioners of hospital medicine who have developed expertise in a rare condition, may improve clinical outcomes, optimize healthcare resources, and provide unique professional and academic opportunities for the clinicians involved.
尽管神经性厌食症患者的死亡率很高，但越来越多的患者能够存活至成年。由于神经性厌食症导致严重营养不良的患者通常需要住院进行医疗稳定，然后才能在饮食失调计划中接受治疗。
我们在丹佛健康医疗中心成立了 ACUTE 中心，以对患有饮食失调症导致严重营养不良的并发症的成年人进行医疗稳定。报告了前 2 年的患者特征和结果。
从 2008 年 10 月到 2010 年 12 月，ACUTE 病房收治了 76 名患者，其中 62 名是为了进行医疗稳定，其中包括 54 名患者。89%的患者为女性。平均年龄为 27 岁（范围 17-65 岁）。入院时的平均体重指数为 12.9kg/m²（标准差[SD]2.0）。入院时，患者存在低钠血症、贫血和白细胞减少症，伴有骨密度降低，但白蛋白水平正常。出院时的平均体重指数为 13.1±1.9kg/m²。中位住院时间为 16 天（四分位间距[IQR]9-29 天）。18%的患者出院回家，82%的患者出院至住院精神病饮食失调病房。住院期间无死亡。
患有这种程度的由饮食失调引起的严重营养不良的患者具有较高的医疗复杂性，且相对少见。区域专科卓越中心由擅长罕见疾病的医院医生领导的多学科团队组成，可能会改善临床结果、优化医疗资源，并为参与的临床医生提供独特的专业和学术机会。
