CHICAGO – Overweight children are 20% more likely to visit the emergency department than are normal-weight children, and they do so for reasons other than injuries and accidents, according to a nationally representative survey.
"I suspect that a big reason we’re seeing this increase in the overweight is that they have chronic conditions that are getting them to the ED," lead author James Dziura, Ph.D., an epidemiologist in the department of emergency medicine and deputy director of the Yale Center for Analytical Sciences in New Haven, Conn., said in an interview.
Dr. James Dziura
That supposition is supported by an alarming new report showing that the prevalence of prediabetes and diabetes among adolescents aged 12-19 years jumped from 9% in 1999 to 23% in 2008 (Pediatrics 2012 May 21 [doi: 10.1542/peds.2011-1082]).
The current analysis used parent-reported weight and height data for 46,707 children, aged 10-17 years, from the cross-sectional, telephone-administered National Survey of Children’s Health. Body mass index was calculated using sex-specific BMI for age growth charts from the Centers for Disease Control and Prevention. Children were categorized as underweight (BMI percentile of 5 or less), normal weight (more than 5 to less than 85), at risk for overweight (85 to less than 95), and overweight (95 or more).
Overall, 15.5% of children were reported to have used the ED in the past year, with the prevalence of at least one ED visit increasing significantly with BMI percentile, from 13% of underweight children to 15% of normal-weight or at-risk children to 19% of overweight children (P less than .001 for overweight vs. all groups or vs. normal weight). Additionally, overweight children were more likely to have more than one visit, Dr. Dziura reported at the annual meeting of the Society for Academic Emergency Medicine.
After adjustment for age, sex, race, ethnicity, insurance type, parent’s education, and parent’s primary language, the odds ratio for ED use was 1.24 in overweight children, compared with those at normal weight. The impact of BMI category was not significantly modified by sex, race, or Hispanic ethnicity.
In all, 49% of overweight children reported an injury, poisoning, or accident as the reason for their ED visit, compared with 61% of at-risk, 62% of normal-weight, and 63% of underweight children (P less than .05; odds ratio, 0.68 for overweight vs. normal weight). The survey asked only if the children came to the ED for one of those three reasons, so specific data on chronic conditions such as diabetes and asthma are not readily available, Dr. Dziura said.
Still, it’s likely that as rates of childhood obesity continue to skyrocket in the United States, there will be greater demands on the ED and an increased emphasis on the care of chronic conditions.
"Given the numbers that were reported in Pediatrics, ... the types of problems that these children are going into the ED with are totally different than what many people in the ED might have been trained for," he said. "So dealing with chronic conditions is going to be a big part of an ED doctor’s skill set."
The investigators hope to conduct a survey looking at the interaction between BMI and chronic conditions and the types of services given and problems encountered in the ED. Eventually, they hope to design a brief screening and intervention for obesity in the ambulatory setting.
"A lot of these children and parents of these children have never been told by a primary care physician they have a weight problem," he said.
A recent study suggests that despite some progress over the last decade, fewer than a quarter of parents of children with a BMI in the 85th percentile or higher report having been told by a physician or health care provider that their child was overweight (Arch. Pediatr. Adolesc. Med. 2012;166:317-22).
The authors reported having no disclosures.