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Medical Assessment and Triage of Pediatric Patients with Anorexia Nervosa in Primary Care

Homan, Kendra J., PhD*; Sim, Leslie A., PhD*; Crowley, Susan L., PhD; Lebow, Jocelyn R., PhD*; Kransdorf, Lisa N., MD, MPH

Journal of Developmental & Behavioral Pediatrics: February/March 2019 - Volume 40 - Issue 2 - p 92–98
doi: 10.1097/DBP.0000000000000629
Original Article

Objective: To examine the medical assessment and triage of pediatric patients with anorexia nervosa (AN) initially seen in primary care.

Methods: 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.

Results: 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).

Conclusion: 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.

*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; and

Division of Internal Medicine and Pediatrics, University of California, Los Angeles, CA.

Address for reprints: Kendra J. Homan, PhD, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229; e-mail:

Disclosure: The authors declare no conflict of interest.

Received May 15, 2018

Accepted October 27, 2018

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