Low rates of obesity documentation in the pediatric emergency department
2Exercise, Nutrition and Lifestyle Clinic, Edmond and Lily Safra Children's Hospital, Sheba Medical Center
Background: Obesity is the most prevalent chronic disease in children, affecting nearly 13% of Israeli children and adolescents. Its identification is a crucial step in initiating a treatment process, yet performed in less than half of primary-care visits. Pediatric emergency department (PED) visits are an excellent opportunity to identify obesity, due to their high volume and regular weight measurements.
Aim: To determine the frequency of obesity documentation in the PED and to identify its predictors.
Methods: Chart review of all tertiary PED visits by children and adolescents during 2010-2019 (n=150,250). In the absence of height data, obesity was defined as weight >90%th percentile (Gamliel 2015). Main outcomes were obesity documentation and referral recommendations in charts of children with obesity (n=16,413). Mixed models were used to identify predictors for obesity documentation using age, sex, weight, visit month and time of day.
Results: The prevalence of obesity in the study cohort was 13.6% (median age 9.4, 58% males). “OBESITY” as diagnosis was listed in only 240 visits (1.5%) of children with obesity. Text addressing overweight/obesity was recorded in 721 visits (4.4%), and written recommendations for treatment were documented in only 716 (4.4%) of visits by children with obesity. A higher probability of documentation was seen in females, older children, higher weights, and morning visits.
Conclusion: Physicians in the PED rarely address the obesity of visiting children when present. Given the high potential of the PED to identify obesity in children, methods to increase staff engagement in this matter should be developed.