Hospitalization patterns for adolescents with eating disorders during COVID-19

Plain English summaryThe COVID-19 pandemic has had a profound effect on the mental health of young people worldwide. This public health crisis has led to a significant increase in individuals seeking care for an eating disorder. In the United States, hospital admissions for adolescents with eating disorders requiring medical stabilization increased significantly during the COVID-19 pandemic. This study examines differences in the demographic and clinical characteristics of patients with an eating disorder hospitalized pre-COVID-19 and during the COVID-19 pandemic in one pediatric hospital in the United States. We found a significant increase in hospital admissions during the pandemic as well as longer hospital stays. Factors associated with prolonged hospitalizations include those patients with public insurance (Medicaid), nasogastric tube for delivery of nutrition, and low heart rate. We found no difference in demographic factors such as age, gender, and insurance as well as degree of malnutrition and medical severity between the two time periods. The shortage of appropriate eating disorder treatment options upon hospital discharge were especially challenging during the COVID-19 pandemic. PurposeThe 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.MethodsMedical 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 & GE; 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.ResultsOf 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).ConclusionIn 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.