title: What role does body mass index play in hospital admission rates from the pediatric emergency department?
abstract: BACKGROUND
  The primary objective of this study was to determine if children with abnormal body mass index (BMI) percentiles for age were admitted to the hospital from the emergency room at greater frequency than normal-weight children. This study also sought to evaluate what specific diagnoses both underweight and overweight children were being admitted with, and if a discrepancy exists.
  
  
  METHODS
  A prospective observational chart review was conducted of children evaluated in the emergency department of the Children's Hospital at the University of Oklahoma during the month of October 2011 (n = 1747). One thousand nine hundred thirteen patient charts were reviewed, but 166 were excluded because of inability to obtain a height or weight within a 3-month period of the child being seen in the emergency department.
  
  
  RESULTS
  Thirty-five (24.5%) of underweight patients, 82 (14.6%) of overweight or obese, and 173 (16.6%) of the normal-weight patients were admitted to the hospital from the emergency department. The underweight patients were admitted more frequently than the normal-weight (P = 0.0206) and overweight or obese patients (P = 0.0046). In addition, underweight patients were admitted more frequently with respiratory infections than normal-weight (P = 0.0279) and overweight or obese (P = 0.0509) patients. In addition, underweight patients were admitted more than overweight or obese patients with fractures (P = 0.0278). There was no statistical difference between overweight or obese and normal-weight admissions within any of the diagnostic categories.
  
  
  CONCLUSIONS
  Underweight children (BMI ≤5%) have an increased risk of hospitalization from the emergency department, even when adjusted for age and sex. In particular, hospitalization among underweight patients was increased for those patients with respiratory infections and fractures. No difference was seen between admission rates of overweight (BMI ≥85%) or obese (BMI ≥95%) patients from those of normal-weight patients. This warrants the need to counsel patients and their families on the dangers not only of obesity, but also of being underweight. Emphasis should be placed on healthy lifestyles that include well-balanced meals and exercise.
authors: From *University of Oklahoma Health Sciences Center, Oklahoma City, OK, and †Indianapolis, IN.
authors: Sara
authors: S
authors: Wyrick
authors: Casey
authors: C
authors: Hester
authors: Amy
authors: A
authors: Sparkman
authors: Kathleen M
authors: KM
authors: O'Neill
authors: Greg
authors: G
authors: Dupuis
authors: Michael
authors: M
authors: Anderson
authors: Jared
authors: J
authors: Cordell
authors: Amanda
authors: A
authors: Bogie
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology; D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003953:Diagnosis-Related Groups; D004198:Disease Susceptibility; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007239:Infections / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000150:complications; D009422:Nervous System Diseases / Q000453:epidemiology; D009825:Oklahoma / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012306:Risk; D013851:Thinness / Q000453:epidemiology / Q000209:etiology; D014947:Wounds and Injuries / Q000453:epidemiology