Schlapfer Leslie, Gettis Margaret A, Dutreuil Valerie, Cherven Brooke
Children's Healthcare of Atlanta, 1001 Johnson Ferry Rd NE, Atlanta, GA, USA.
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
J Eat Disord. 2023 Aug 16;11(1):137. doi: 10.1186/s40337-023-00867-z.
The purpose of this study was to examine differences in clinical characteristics and hospital length of stay (LOS) for adolescents with eating disorders (EDs) requiring medical stabilization during the pre-COVID-19 and COVID-19 time periods.
Medical record data were abstracted for patients with EDs hospitalized for medical stabilization between 1/1/2019-2/29/2020 (pre-COVID-19) and 3/1/2020-12/31/2021 (during COVID-19). Patient demographics, clinical characteristics and LOS were compared between COVID-19 eras. Patients were categorized as boarding if they remained hospitalized ≥ 1 day after medical stabilization. Multivariate negative binomial linear regression models were performed to determine incidence rate ratios (IRR) and 95% confidence intervals (95% CI) for factors related to increased LOS.
Of the 467 admissions during this study, 120 were pre-COVID-19 and 347 were during COVID-19. Monthly admissions for EDs were higher during COVID-19 versus pre-COVID-19 (15.8 vs. 8.6, p = 0.001). On multivariate analysis, factors associated with increased LOS included admission during COVID-19 (IRR 1.27, 95% CI 1.15-1.40), p = 0.001), boarding (IRR 1.77, 95% CI 1.63-1.93, p = 0.001), public insurance (IRR 1.12, 95% CI 1.01-1.23, p = 0.032), nasogastric tube usage (IRR 1.62, 95% CI 1.48-1.76, p = 0.001), heart rate < 40 beats per minute (IRR 1.21, 95% CI 1.11-1.33, p = 0.001) and abnormal electrocardiogram (IRR 1.25, 95% CI 1.14-1.37, p = 0.001).
In addition to clinical factors, we found that admission during COVID-19, boarding, and public insurance were associated with increased LOS among patients with EDs. There is a need for greater availability of ED treatment centers to care for patients with EDs after medical stabilization.
本研究旨在探讨在新冠疫情前和新冠疫情期间，因饮食失调（ED）需要医疗稳定的青少年在临床特征和住院时间（LOS）方面的差异。
提取了2019年1月1日至2020年2月29日（新冠疫情前）和2020年3月1日至2021年12月31日（新冠疫情期间）因ED住院进行医疗稳定治疗的患者的病历数据。比较了新冠疫情不同时期患者的人口统计学特征、临床特征和住院时间。如果患者在医疗稳定后仍住院≥1天，则被归类为留观患者。进行多变量负二项线性回归模型，以确定与住院时间延长相关因素的发病率比（IRR）和95%置信区间（95%CI）。
在本研究的467例入院患者中，120例在新冠疫情前，347例在新冠疫情期间。与新冠疫情前相比，新冠疫情期间ED的月入院率更高（15.8对8.6，p = 0.001）。多变量分析显示，与住院时间延长相关的因素包括新冠疫情期间入院（IRR 1.27，95%CI 1.15 - 1.40，p = 0.001）、留观（IRR 1.77，95%CI 1.63 - 1.93，p = 0.001）、公共保险（IRR 1.12，95%CI 1.01 - 1.23，p = 0.032）、鼻胃管使用（IRR 1.62，95%CI 1.48 - 1.76，p = 0.001）、心率<40次/分钟（IRR 1.21，95%CI 1.11 - 1.33，p = 0.001）和心电图异常（IRR 1.25，95%CI 1.14 - 1.37，p = 0.001）。
除临床因素外，我们发现新冠疫情期间入院、留观和公共保险与ED患者的住院时间延长有关。需要增加ED治疗中心的可及性，以便在医疗稳定后照顾ED患者。
