736 The incidence and management of paediatric eating disorders requiring admission to a hospital in South-East Ireland over a five-year period

• Published in: Archives of disease in childhood Vol. 108; no. Suppl 2; pp. A372 - A373
• Main Authors: Kerswill, Suzanne, Kuhar, Maja, Attia kalim, Parker, Sorcha
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2023
• Subjects: Adolescents; Child & adolescent psychiatry; Children; COVID-19; Eating disorders; Emergency medical care; Guidelines; Morbidity; Pandemics; Patients; Pediatrics; Psychiatry; Risk assessment; Self-injury; Statistics; Teenagers; Trends; Urinalysis; Ireland
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.588

ObjectivesEating disorders have the highest mortality and morbidity risk of all mental health disorders. (1) The incidence of early onset eating disorders has been increasing (2,3), especially during the COVID 19 pandemic (4,5). We set out to describe the burden of disease and trends of eating disorders requiring admission to a general paediatric ward in South-East Ireland over a five-year period, and to audit the management of these patients according to the previously used MARSIPAN risk stratification tool as well as the CHI (Children’s Health Ireland) protocol for the management of patients with eating disorders.MethodsThis retrospective descriptive study gathered patient details from an existing register of all paediatric mental-health admissions to our facility. All patients between the ages of 5 and 18 who were admitted with eating disorders between August 2016 and October 2021 were included. An individual folder review was conducted to assess adherence to the MARSIPAN and CHI guidelines – 15 available folders met criteria and were included.ResultsThe average age at admission was 13.7 years. 40% of patients admitted were 11–13 years old, there were no patients younger than 10 years of age. 86.7% were female.Figure 1 shows the trends in admissions over time. A surge in admissions was noted during the COVID-19 pandemic, with 17 admissions from January 2020 to October 2021 compared with only 7 admissions in the preceding 3 years.Comorbid conditions were common, and 33% of patients suffered from depression and 26% suffered from anxiety. In terms of MARSIPAN risk assessment, 1 patient (6%) was assessed as moderate risk, while the remainder were not risk-stratified or were incompletely assessed. The CHI Guidelines were generally well adhered to: 93% of patients had a documented weight and 80% had a documented height on admission. Appropriate admission bloods were done on 93%, and 80% had an ECG within 24 hours. All patients were seen by a dietitian and 80% by a psychiatrist.Areas for improvement were identified as follows: only one patient had orthostatic vitals and urinalysis done on admission. Documentation of clear treatment goals and discussion with patient families was suboptimal at only 33%.Abstract 736 Figure 1ConclusionsPaediatric eating disorders requiring admission to WGH increased significantly over the COVID-19 pandemic. MARSIPAN guidelines were under-utilised as a risk stratification tool. Local implementation of the new MEED guidelines (Medical Emergencies in Eating Disorders) should take previous areas of programmatic strengths and weakness into account.ReferencesPriory (2019). Eating Disorder Statistics | Priory Group. [online] Priorygroup.com. Available at: https://www.priorygroup.com/eating-disorders/eating-disorder-statistics.Nicholls DE, Lynn R, Viner RM. (2011) ‘Childhood eating disorders: British national surveillance study,’ British Journal of Psychiatry, Cambridge University Press, 198(4), pp. 295–301.Hudson LD, Nicholls DE, Lynn RM, Viner RM. Medical instability and growth of children and adolescents with early onset eating disorders. Archives of Disease in Childhood, 2012;97(9):779–784. doi:10.1136/archdischild-2011-301055.Ougrin D, Wong BH, Vaezinejad M, Plener PL, Mehdi T, Romaniuk L, Barrett E, Hussain H, Lloyd A, Tolmac J, Rao M, Chakrabarti S, Carucci S, Moghraby OS, Elvins R, Rozali F, Skouta E, McNicholas F, Kuruppuaracchi N, Stevanovic D. Pandemic-related emergency psychiatric presentations for self-harm of children and adolescents in 10 countries (PREP-kids): a retrospective international cohort study. European Child & Adolescent Psychiatry, [online] 2021;1–13. doi:10.1007/s00787-021-01741-6.McDonnell T, Conlon C, McNicholas F, Barrett E, Barrett M, Cummins F, Hensey C, McAuliffe E, Nicholson E. Paediatric hospital admissions for psychiatric and psychosocial reasons during the first year of the COVID-19 pandemic. International Review of Psychiatry 2022;34(2):128–139. doi:10.1080/09540261.2022.2061840.