Department 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.
Department of Psychology, Utah State University, Logan, UT.
J Dev Behav Pediatr. 2019 Feb/Mar;40(2):92-98. doi: 10.1097/DBP.0000000000000629.
To examine the medical assessment and triage of pediatric patients with anorexia nervosa (AN) initially seen in primary care.
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.
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).
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.
研究在初级保健中首次就诊的厌食症（AN）儿科患者的医学评估和分诊。
对 2010 年 1 月 1 日至 2016 年 12 月 31 日期间，在单一医疗系统中，因进食/体重问题且最初在初级保健中发现 AN 症状的所有 AN 儿科患者进行回顾性队列研究。从病历中提取就诊关注点、医学评估/实验室检查、临床诊断、治疗建议和转诊信息。
41 例（平均年龄=13.7 岁，标准差=2.2）患有 AN 的儿科患者因进食/体重问题且最初在初级保健中发现症状。总体而言，只有 5%（n=2/41）的患者在就诊时即被诊断为 AN；少数患者接受电解质紊乱评估（n=20）、心电图异常评估（n=18）、低体温评估（n=13）、暴食/清肠行为评估（n=13）、体位性低血压评估（n=2）或脱水评估（n=1），仅有 56%（n=23）的患者接受了符合实践建议的分诊。尽管 61%（n=25）符合住院标准，但仅建议 2 名患者住院。接受符合实践建议的分诊的患者接受 AN 诊断和治疗的时间明显早于未接受者（p<0.01 和 p=0.001）。
研究结果表明，在初级保健环境中，AN 儿科患者可能未接受医学评估和分诊。了解儿科进食障碍循证护理的障碍，可能有助于为提供者提供教育，并对系统进行全面改革，以改善这些患者的结局。
