258 - Use of Health Services in Pediatric Patients Prior to Eating Disorder Diagnosis

Publication Number: 3248.258

Amy D. Thompson, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States; Claire Loiselle, Nemours Children's Hospital, Wilmington, DE, United States

Background: Eating disorders affect approximately 5% of adolescents, and early identification improves recovery outcomes. Although annual screening by primary care providers is recommended, adolescents often have low rates of preventive care visits. Identifying the last point of healthcare contact prior to diagnosis may reveal alternative opportunities for screening.

Objective: Our objective was to describe the most recent healthcare encounters prior to diagnosis among pediatric patients with eating disorders.

Design/Methods: We conducted a retrospective cross-sectional study of patients aged 10 years and older who were evaluated at a tertiary care pediatric hospital eating disorder clinic between January 1, 2022, and December 31, 2023. Eligible patients were identified using ICD codes and included only if they completed an initial diagnostic evaluation at the eating disorder clinic. For each patient, we reviewed electronic medical records to capture all healthcare visits occurring in the 18 months preceding the first eating disorder clinic visit at which the diagnosis was established. Clinical data collected included patient demographics, type of healthcare encounter, and visit chief complaint. Descriptive statistics were used to summarize patient characteristics and healthcare encounters, with frequencies for categorical variables and medians with interquartile ranges (IQRs) for continuous variables.

Results: Of the 122 patients who met inclusion criteria, 98 (80.3%) were diagnosed with anorexia nervosa, 4 (3.3%) with bulimia nervosa, 4 (3.3%) with avoidant/restrictive food intake disorder (ARFID), and 12 (9.8%) with an unspecified eating disorder. The median age at diagnosis was 14.7 years (IQR: 11.5–14.7). In the 18 months preceding diagnosis, 79 patients (64.7%) had visits with their general pediatrician, and 50 (41.0%) had emergency department (ED) visits at the tertiary care pediatric hospital. Of these, 16 patients (13.1%) were seen in the ED but had no documented visits with a general pediatrician. Top common chief complaints to the ED included orthopedic injuries, mental health concerns (different than eating disorder), and gastrointestinal complaints but syncope, dizziness, and chest pain were additional frequent complaints.

Conclusion(s): Many adolescents diagnosed with eating disorders had recent healthcare encounters in the emergency department. These findings highlight missed opportunities for earlier screening and suggest that incorporating eating disorder assessments into diverse clinical settings such as the ED may improve timely diagnosis.