This is an observational study of current practices on the Medical Behavioral Unit (MBU) at Rady Children’s Hospital San Diego (RCHSD)/UCSD. A retrospective chart review was conducted among patients admitted between January 2015 and March 2016. RCHSD is the only children’s hospital in San Diego County, serving several neighboring counties in Southern California. The MBU is an inpatient unit at RCHSD with 10 medical-surgical beds for patients with medical complications of malnutrition.
Patients were included if they were diagnosed with AN, Other Specified Eating Disorder or Avoidant Restrictive Food Intake Disorder (ARFID) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [19 ], and met medical criteria for hospitalization. Hospitalization criteria were based on those recommended by the Society for Adolescent Health and Medicine [8 ] and include: weight <75% of the expected body weight (EBW); resting heart rate (HR) < 45 beats per minute (bpm) while asleep or <50 bpm while awake; hypotension (<90/45 mmHg); body temperature < 35.6° Celsius; orthostatic change in systolic blood pressure (SBP) > 20 mmHg or diastolic blood pressure (DBP) > 10 mmHg; orthostatic change in HR > 30 bpm; syncope, arrhythmia, heart failure, or symptomatic pericardial effusion related to malnutrition or refeeding; dehydration; electrolyte disturbance related to malnutrition, refeeding, vomiting, or laxative/diuretic abuse; or acute food refusal necessitating tube-feeding or non-enteric feeding.
Patients were between the ages of 8 and 20 years old and were included in the analysis if this was their first or second admission to the (MBU), with no previous admission to the MBU in the preceding 30 days. Patients were excluded if they had a diagnosis of bulimia nervosa (n = 1), left the hospital against medical advice (n = 3), or were transferred to another medical or psychiatric facility (n = 2). Human subjects approval was obtained from the UCSD Human Research Protections Program Institutional Review Board.
Patients were included if they were diagnosed with AN, Other Specified Eating Disorder or Avoidant Restrictive Food Intake Disorder (ARFID) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [19 ], and met medical criteria for hospitalization. Hospitalization criteria were based on those recommended by the Society for Adolescent Health and Medicine [8 ] and include: weight <75% of the expected body weight (EBW); resting heart rate (HR) < 45 beats per minute (bpm) while asleep or <50 bpm while awake; hypotension (<90/45 mmHg); body temperature < 35.6° Celsius; orthostatic change in systolic blood pressure (SBP) > 20 mmHg or diastolic blood pressure (DBP) > 10 mmHg; orthostatic change in HR > 30 bpm; syncope, arrhythmia, heart failure, or symptomatic pericardial effusion related to malnutrition or refeeding; dehydration; electrolyte disturbance related to malnutrition, refeeding, vomiting, or laxative/diuretic abuse; or acute food refusal necessitating tube-feeding or non-enteric feeding.
Patients were between the ages of 8 and 20 years old and were included in the analysis if this was their first or second admission to the (MBU), with no previous admission to the MBU in the preceding 30 days. Patients were excluded if they had a diagnosis of bulimia nervosa (n = 1), left the hospital against medical advice (n = 3), or were transferred to another medical or psychiatric facility (n = 2). Human subjects approval was obtained from the UCSD Human Research Protections Program Institutional Review Board.
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