title: Medical stabilization of adolescents with nutritional insufficiency: a clinical care path.
abstract: OBJECTIVE
  Nutritional insufficiency (NI) is a potential consequence of restrictive eating disorders. NI patients often require hospitalization for refeeding to restore medical stability and prevent complications such as refeeding syndrome. Limited information is available on the optimal approach to refeeding. In this study, we describe an inpatient NI care path and compare treatment outcomes at an academic medical center and a community hospital.
  
  
  METHODS
  A retrospective chart review was conducted on inpatients treated using a standardized NI care path at either the academic site, from August 2012 to July 2013 (n = 51), or the community site, from August 2013 to July 2014 (n = 39). Demographic information, eating disorder history, and treatment variables were recorded for each patient. Data were compared using the Kruskal-Wallis test and Fisher's exact test.
  
  
  RESULTS
  Patients admitted to the community site had shorter hospital stays than patients admitted to the academic site (IQR 2-4 vs. 2-7 days, p = 0.03). All patients were discharged in <14 days with a median stay of 3 days. The median initial calorie prescription was 2200 calories for both groups. No clinical cases of refeeding syndrome occurred, with only one patient developing hypophosphatemia during refeeding.
  
  
  CONCLUSIONS
  A standardized care path with a higher-calorie intervention allows for short-term hospitalization of NI patients without increasing the risk of refeeding syndrome, regardless of treatment site. This study demonstrates the efficiency and safety of treating NI patients on a regular medical floor at a community hospital.
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Mail Code NA21, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. strands@ccf.org.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Strandjord
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Mail Code NA21, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Erin H
authors.initials: EH
authors.lastname: Sieke
authors.affiliation: Office of Civic Education Initiatives Internship Program, Cleveland Clinic, 25875 Science Park Drive/AC121, Beachwood, OH, 44122, USA.
authors.forename: Miranda
authors.initials: M
authors.lastname: Richmond
authors.affiliation: Office of Civic Education Initiatives Internship Program, Cleveland Clinic, 25875 Science Park Drive/AC121, Beachwood, OH, 44122, USA.
authors.forename: Arjun
authors.initials: A
authors.lastname: Khadilkar
authors.affiliation: Department of General Pediatrics, Cleveland Clinic Children's Hospital, 9500 Euclid Ave/A120, Cleveland, OH, 44195, USA.
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Rome
mesh_terms: D000293:Adolescent; D002648:Child; D001068:Feeding and Eating Disorders / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D009752:Nutritional Status; D012189:Retrospective Studies; D015430:Weight Gain; D055815:Young Adult
keywords: Care path; Eating disorder; Inpatient; Length of stay; Nutritional insufficiency; Refeeding