Variations in admission practices for adolescents with anorexia nervosa: a North American sample

Abstract

Purpose: The purpose of this study was to assess the variability in admission practices and medical inpatient care for adolescent patients with anorexia nervosa (AN).

Methods: Participants consisted of members of the 2001-2003 Eating Disorder Special Interest Group from the Society for Adolescent Medicine who completed a structured telephone interview about their admission practices and patterns of inpatient care for teens with AN. Questions focused on admission threshold for heart rate (HR), percentage of ideal body weight (% IBW), and refeeding protocols. Case vignettes were used.

Results: Of 95 eligible practitioners, 51 (53%) agreed to participate. Participants represented 25 American states, one Canadian province, and 45 different adolescent programs. The majority of physicians reported they would hospitalize an AN patient with HR <40 beats/min. The most common response for when to hospitalize based on % IBW was 75% IBW. There were no differences in admission practices based on number of years in practice, gender of physician, or practice setting. Regional differences in admission practices were noted, with physicians in the western United States less likely to admit patients with HR >or=40 beats per minute (p = .018). Physicians described 28 different methods of advancing a diet during an admission. Only 37% of physicians were aware of a standardized refeeding protocol in their institution.

Conclusion: This study indicates variability in admission criteria and refeeding practices and shows evidence of geographic variations of admission standards. These data provide a baseline for outcome trials investigating medical admissions for adolescents with AN.