Editor’s Note: Claire Castellano will be graduating from Emory University School of Medicine this spring and starting her pediatric residency. In addition to her MD, Claire pursued a Master’s in Public Health at Emory, focusing on global epidemiology. She spent this past summer living and working in Dar es Salaam, Tanzania. Claire hopes to combine her interests in medical education and global health in her career as a pediatrician.
- Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
The COVID-19 pandemic presented new challenges for physical and mental health for children and young adults in the US; they faced a unique set of challenges when schools abruptly closed, disrupting the structure, patterns, and support systems that nearly 60 million students previously relied on. In particular, rates of depression, anxiety, and eating disorders rose during this time of stress and uncertainty, and this has increased burden and strain on both individuals and the healthcare system.
An article by Carly Milliren, Dr. Tracy Richmond, and Dr. Joel Hudgins at Boston Children’s Hospital, which is being early released this week in Pediatrics, describes trends in emergency department (ED) visits and inpatient admissions for patients with eating disorders across 38 tertiary pediatric hospitals between January 2018 and June 2022 (10.1542/peds.2022-058198). This cohort study defined pre-COVID-19 as the 27 months prior to March 2020 and post-COVID-19 as the 27 months after March 2020.
The authors highlighted multiple findings:
- Increased numbers: Compared to pre-COVID-19 levels, both ED visits and in-patient admissions for eating disorders increased nearly 2-fold in the first year post-COVID-19. The rate of increase in ED visits pre-COVID-19 was 1.5 visits/month, and this rate increased to 12.9 visits/month. In-patient admissions similarly increased from 1.7 admissions/month to 11.9 admissions/month.
- Increased severity: Inpatient admissions for eating disorders were longer (65% increase in average bed-days) post-COVID-19 then pre-COVID-19, suggesting that the severity of eating disorders increased in the post-COVID-19 period.
- Sustained increase in rates: Although the number of both ED visits and inpatient admissions decreased in the second year post-COVID-19, these numbers, especially for ED visits, remained higher than pre-COVID-19 numbers.
The authors acknowledge that analysis of only tertiary pediatric hospitals and eating disorder as the principal discharge diagnosis limits the generalizability and potentially underestimates the actual impact of eating disorders on patients and hospitals. Further work is also needed to explore documented disparities, with differences in eating disorder diagnoses based on race, insurance, and other sociodemographic factors, to create more equal and equitable access to care for eating disorders.
However, these findings have important implications. Care of a patient with an eating disorder requires complex care coordination and many resources. The ED is not designed to manage such care, and trying to do so likely strains an already strained workforce and system. The authors suggest that the increase in ED visits and admissions may be due to a combination of fewer available outpatient resources for patients with eating disorders and increased severity of disease, prompting the need for more emergent care. If the incidence and severity of eating disorders remain high, we must find sustainable ways to care for this vulnerable patient population in a healthcare system that continues to struggle with the ongoing strain from the pandemic and most recently a surge in other respiratory viruses as well.