Although clear BMI definitions of pediatric weight problems exist, a large percentage of overweight and obese patients remain undiagnosed. Diagnosis increased during the study period but remained low among overweight children, for whom early intervention may be more effective. Identification of overweight and obese patients is the first step in addressing this growing epidemic.

This study revealed a steady increase in the number of patients seen in the emergency department with community-acquired CDAD. Findings from this study suggest that the characteristics of CDAD in children--a population that has not been considered to be at high risk for this disease in the past--are changing. Further investigations are warranted to explore deviations from the established burdens of the disease and patient risk factors.

Obesity is becoming an increasingly prevalent problem among American children. Screening for obesity associated comorbid conditions has been shown to be inconsistent. The current study was undertaken to explore patterns of ordering screening tests among obese pediatric patients. We analyzed electronic medical records (EMR) from 69,901 patients ages 2-18 years between June 1999 and December 2008. Obese children who had documented diagnoses of obesity were identified based on International Classification of Diseases, Ninth Revision codes. Screening rates for glucose, liver, and lipid abnormalities were assessed. Regression analysis was used to examine impact of patient characteristics and temporal trends were analyzed. Of the 9,251 obese diagnosed patients identified, 22% were screened for all three included obesity-related conditions: diabetes, liver, and lipid abnormalities; 52% were screened for glucose abnormalities; 30% for liver abnormalities; and 41% for lipid abnormalities. Increasing BMI and age were associated with increased rates of screening. Females and Hispanic patients were more likely to be screened. The majority of screening was ordered under "basic metabolic panel," "hepatic function panel," and "full lipid profile" for each respective condition. The percentages of patients screened generally increased over time, although the percentages screened for diabetes and lipid abnormalities seemed to plateau or decrease after 2004. Even after diagnosis, many obese patients are not receiving recommended laboratory screening tests. Screening increased during the study period, but remains less than ideal. Providers could improve care by more complete laboratory screening in patients diagnosed with obesity.

These results imply that paediatric providers may not use family history as a screening tool for assessing future risk of obesity and hypertension, but instead gather this information after these chronic conditions have developed, making it difficult to implement preventative or screening strategies based on familial risk.

Hypertension among pediatric patients is an underdiagnosed condition. As continuity of care has been found to increase quality of pediatric care, we undertook this study to assess effect of continuity on diagnosis of pediatric hypertension. This is a retrospective analysis of 774 hypertensive patients, ages 3-18 years between June 1999 and October 2007 within the MetroHealth System in northeastern Ohio. The proportion of hypertensive patients diagnosed was assessed using coding within the electronic medical record. Continuity was assessed using the usual provider of care, defined as the number of visits to the most frequent provider divided by the total number of visits in the study period. Overall continuity did not have a statistically significant association with diagnosis (OR 0.7, CI 0.4-1.4). Our research indicates that continuity does not significantly affect diagnosis of hypertension in pediatric patients. Other approaches should be investigated to improve the significant underdiagnosis of pediatric hypertension.