143 - Effect of COVID-19 on Prevalence and Severity of Eating Disorder Admissions in a Specialized Pediatric Inpatient Unit

Poster Number: 143
Publication Number: 143.299

Background: In light of COVID-19, people all over the world experienced social distancing. Thus, youth missed crucial parts of social development. Research evaluating effects of isolation on adolescent mental health and eating disorders demonstrated increased ED visits during COVID.

Objective: To assess the prevalence and severity of eating disorder symptoms among adolescent patients admitted to a specialized inpatient eating disorder unit.

Design/Methods: A retrospective chart review of patients admitted to the Medical-Behavioral Unit (MBU) at Rady Children’s Hospital San Diego (RCHSD) from January 2019 through November 2021 was conducted. Differences in number of admissions and patient admission characteristics were compared before and after the start of the COVID-19 stay-at-home mandate. Bivariate analysis using chi-square and t-tests were performed. Logistic and linear regression models, adjusting for age, sex, and insurance, were created for multivariate analyses.

Results: Data from 208 patients (13% male, 15.4% on Medicaid, median age 15 years) over 35 months were analyzed. Average number of admissions per month before and after the onset of the pandemic was 4.21 (range = 2-8) and 7.38 (range = 4-15) respectively (p < 0.001). No differences were noted between time periods regarding percent of target goal weight, lab values, orthostatic vital signs, need for readmission within 90 days, nasogastric tubes, and restraints. However, bivariate analysis showed lower systolic blood pressures (SBP) (p = 0.02) and diastolic blood pressures (DBP) (p < 0.01) in patients pre- versus post- COVID. Results were similar in the adjusted models (SBP’s (-3.12 [95% CI -5.65 to -0.59]), DBP’s (-3.42 [95% CI -5.64 to -1.21])). Patients admitted pre-COVID also had higher rates of refeeding syndrome (p < 0.01). There was a significant interaction between refeeding syndrome and age. After adjusting for covariates, patients admitted pre-COVID who were < 15 years had higher rates of refeeding syndrome (45.0%) than those during COVID (6.35%) p < 0.001). There were no differences in prevalence of refeeding syndrome in patients > 15 years (p = 0.24).

Conclusion(s): Unexpectedly, some clinical characteristics on admission were more severe in the pre-COVID era versus during COVID. We had predicted a worsening of symptoms in patients admitted during the COVID pandemic. However, closures of many partial hospitalization or outpatient ED programs may have led to lower acuity patients being hospitalized earlier during COVID. Preserving access to robust outpatient eating disorder treatment may prevent this phenomenon during future public health crises.