Brady Cassandra C, Thaker Vidhu V, Lingren Todd, Woo Jessica G, Kennebeck Stephanie S, Namjou-Khales Bahram, Roach Ashton, Bickel Jonathan P, Patibandla Nandan, Savova Guergana K, Solti Imre, Holm Ingrid A, Harley John B, Kohane Isaac S, Crimmins Nancy A
Vanderbilt University School of Medicine, Nashville, TN, USA.
Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Int J Pediatr. 2016;2016:4068582. doi: 10.1155/2016/4068582. Epub 2016 Sep 6.
The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals. We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years). We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children's Hospital and Cincinnati Children's Hospital and Medical Center between 2007 and 2014. A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits) had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older children (15% versus 26%). Documentation was significantly higher in girls (29% versus 17%, < 0.001), African American children (27% versus 19% in whites, < 0.001), and the obesity focused specialty clinics (70% versus 15% in primary care and 9% in other subspecialty clinics, < 0.001). There is significant opportunity for improvement in documentation of obesity in young children, even years after the 2007 AAP guidelines for management of obesity.
在过去十年中，儿童重度肥胖的患病率翻了一番。本研究的目的是确定两家大型三级儿科医院中BMI≥第99百分位数的幼儿肥胖的临床记录情况。我们使用一种标准化算法，利用电子健康记录中的数据来识别重度早发性肥胖儿童（年龄<6岁时BMI≥第99百分位数）。我们提取描述性术语和ICD - 9编码，以评估2007年至2014年期间波士顿儿童医院和辛辛那提儿童医院及医疗中心的肥胖记录情况。共识别出2588名重度早发性肥胖儿童的9887次就诊记录。根据肥胖记录的预定义标准，21.5%的儿童（13.5%的就诊）有阳性记录，且因机构而异。首次就诊年龄在2岁以下的儿童的记录低于年龄较大的儿童（15%对26%）。女孩（29%对17%，P<0.001）、非裔美国儿童（白人中为27%对19%，P<0.001）以及肥胖专科诊所（初级保健中为70%对15%，其他亚专科诊所中为9%，P<0.001）的记录明显更高。即使在2007年美国儿科学会肥胖管理指南发布多年后，幼儿肥胖记录仍有很大的改进空间。
