Considering a risk profile based on emergency department utilization in young people with eating disorders: Implications for early detection

Abstract

Objective: While screening tools are available for the early identification of eating disorders, it may not be feasible to employ them in an emergency department (ED). Establishing a risk profile may improve the screening process. The purpose of this study was to investigate ED service utilization among patients with eating disorders and create a risk profile to help detect eating disorders at an earlier and more treatable stage.Method: We applied a concurrent mixed methods research design, however, only the quantitative findings will be presented. Our study involved a retrospective cohort analysis of administrative ED health data for patients (n = 243) aged 12-24 years in an eating disorders program. Two control groups: (1) all-cause (n = 716), (2) and mental health (n = 679) were included.Results: 68.7% of eating disorder patients were discharged from the ED without followup being arranged. Comorbidities were recorded as the primary or secondary diagnosis, and patients presented with suicidality more frequently than controls (χ = 31.2, p < .001). Patients accessed ED services five times more often than controls.Discussion: Despite eating disorder patients accessing the ED more frequently than controls, eating disorder diagnoses were not always assigned or documented. Our findings highlight the importance of enhanced eating disorder training for ED health care staff to better understand the risk profile, and the consideration of comorbidities and suicide risk when assessing patients to ensure early detection. Conclusion:As eating disorders are often undetected, more comprehensive training and access to screening tools may help improve detection, mitigate symptom progression, and enhance patient safety.

A retrospective cohort study examining health care utilization patterns in individuals diagnosed with an eating disorder in childhood and/or adolescence

“…Our findings can be compared to a recent study from Alberta, Canada by Redekopp and colleagues (Redekopp et al, 2021) who examined emergency department use. They studied 243 patients from their ED clinic aged 12–24 years matched to a general population cohort and a mental health cohort.…”

“…We chose a period of surveillance of 4 years in total (2 years prior to diagnosis, and 2 years following diagnosis). This decision was partly based on prior literature also using 2 years of pre (Hung et al, 2017) and/or post data (Redekopp et al, 2021) but also to maximize our study sample. A longer period of surveillance would have reduced our sample size.…”

“…We also found much higher emergency department utilization compared to the general population, however, we found lower emergency department utilization compared to our mood disorder cohort for both mental health and nonmental health related outcomes. Perhaps this is due to the fact that Redekopp (Redekopp et al, 2021) used a cohort with all types of mental health diagnoses, whereas we used a more specific group of individuals with significant mood disorders.…”

“…These authors also found an ED diagnosis was not always assigned or documented in the emergency department (Redekopp et al, 2021). Furthermore, they suggested patients with EDs are not screened appropriately and often leave without follow-up (Redekopp et al, 2021).…”

“…These authors also found an ED diagnosis was not always assigned or documented in the emergency department (Redekopp et al, 2021). Furthermore, they suggested patients with EDs are not screened appropriately and often leave without follow-up (Redekopp et al, 2021). These authors concluded that emergency department residents and medical students receive little training and feel apprehensive if signs for an ED are ambiguous (Ma et al, 2021).…”