Milliren Carly E, Crowley McGreggor, Carmody Julia K, Bern Elana M, Eldredge Olivia, Richmond Tracy K
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA.
J Eat Disord. 2024 Mar 25;12(1):42. doi: 10.1186/s40337-024-00996-z.
Avoidant restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder added to the DSM-5 in 2013 and ICD-10 in 2018. Few studies have examined hospital utilization for patients with ARFID specifically, and none to date have used large administrative cohorts. We examined inpatient admission volume over time and hospital utilization and 30-day readmissions for patients with ARFID at pediatric hospitals in the United States.
Using data from the Pediatric Health Information System (PHIS), we identified inpatient admissions for patients with ARFID (by principal International Classification of Diseases, 10th Revision, ICD-10 diagnosis code) discharged October 2017-June 2022. We examined the change over time in ARFID volume and associations between patient-level factors (e.g., sociodemographic characteristics, co-morbid conditions including anxiety and depressive disorders and malnutrition), hospital ARFID volume, and hospital utilization including length of stay (LOS), costs, use of enteral tube feeding or GI imaging during admission, and 30-day readmissions. Adjusted regression models were used to examine associations between sociodemographic and clinical factors on LOS, costs, and 30-day readmissions.
Inpatient ARFID volume across n = 44 pediatric hospitals has increased over time (β = 0.36 per month; 95% CI 0.26-0.46; p < 0.001). Among N = 1288 inpatient admissions for patients with ARFID, median LOS was 7 days (IQR = 8) with median costs of $16,583 (IQR = $18,115). LOS and costs were highest in hospitals with higher volumes of ARFID patients. Younger age, co-morbid conditions, enteral feeding, and GI imaging were also associated with LOS. 8.5% of patients were readmitted within 30 days. In adjusted models, there were differences in the likelihood of readmission by age, insurance, malnutrition diagnosis at index visit, and GI imaging procedures during index visit.
Our results indicate that the volume of inpatient admissions for patients with ARFID has increased at pediatric hospitals in the U.S. since ARFID was added to ICD-10. Inpatient stays for ARFID are long and costly and associated with readmissions. It is important to identify effective and efficient treatment strategies for ARFID in the future.
回避性限制性食物摄入障碍（ARFID）是一种相对较新的进食障碍，于2013年被纳入《精神疾病诊断与统计手册》第5版（DSM-5），并于2018年被纳入《国际疾病分类》第10版（ICD-10）。很少有研究专门考察ARFID患者的住院情况，迄今为止也没有研究使用大型管理队列。我们研究了美国儿科医院中ARFID患者的住院入院量随时间的变化、住院情况以及30天再入院情况。
利用儿科健康信息系统（PHIS）的数据，我们确定了2017年10月至2022年6月出院的ARFID患者（根据国际疾病分类第10版，ICD-10主要诊断代码）的住院入院情况。我们研究了ARFID入院量随时间的变化，以及患者层面因素（如社会人口统计学特征、包括焦虑和抑郁障碍及营养不良在内的共病情况）、医院ARFID入院量与住院情况（包括住院时长、费用、入院期间肠内管饲或胃肠道成像的使用情况）和30天再入院情况之间的关联。采用校正回归模型来研究社会人口统计学和临床因素与住院时长、费用及30天再入院情况之间的关联。
44家儿科医院的ARFID住院入院量随时间增加（每月β = 0.36；95%置信区间0.26 - 0.46；p < 0.001）。在1288例ARFID患者的住院入院病例中，中位住院时长为7天（四分位间距 = 8），中位费用为16,583美元（四分位间距 = 18,115美元）。ARFID患者入院量较高的医院，其住院时长和费用最高。年龄较小、共病情况、肠内喂养和胃肠道成像也与住院时长相关。8.5%的患者在30天内再次入院。在校正模型中，不同年龄、保险类型、首次就诊时的营养不良诊断以及首次就诊时的胃肠道成像检查对再入院可能性存在差异。
我们的结果表明，自ARFID被纳入ICD-10以来，美国儿科医院中ARFID患者的住院入院量有所增加。ARFID患者的住院时间长且费用高，并与再入院相关。未来确定针对ARFID的有效且高效的治疗策略很重要。
