title: Daily Laboratory Monitoring is of Poor Health Care Value in Adolescents Acutely Hospitalized for Eating Disorders.
abstract: This study investigates how the clinical practice guideline-recommended laboratory monitoring for refeeding syndrome impacts management and outcomes of adolescents with eating disorders hospitalized for acute medical stabilization and examines the value of laboratory monitoring (defined as the patient health outcomes achieved per dollar spent).
  
  
  
  A retrospective chart review of medical admissions in a children's hospital between October 2010 and February 2014 was performed. Encounters were identified using International Classification of Diseases, Ninth Revision codes of eating disorders as primary or secondary diagnoses. Exclusion criteria included systemic diseases associated with significant electrolyte abnormalities. Chart abstraction was performed using a predetermined form. Costs were estimated by converting hospital-fixed Medicaid charges using a statewide cost-to-charge ratio.
  
  
  
  Of the 196 patient encounters, there were no cases of refeeding syndrome. A total of 3,960 key recommended laboratories were obtained; 1.9% were below normal range and .05% were critical values. Of these, .28% resulted in supplementation; none were associated with a change in inpatient management. Total laboratory costs were $269,250.85; the calculated health care value of this monitoring is 1.04 × 10(-8) differential outcomes per dollar spent.
  
  
  
  This study provides evidence to suggest that daily laboratory monitoring for refeeding syndrome is a poor health care value in the management of adolescents hospitalized for acute medical stabilization with eating disorders. This initial analysis suggests that starting at a relatively low caloric level and advancing nutrition slowly may negate the need for daily laboratory assessment, which may have important implications for current guidelines.
authors.affiliation: Department of Psychiatry and Human Behavior, Mood Disorders Research Program, Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: Kathryn_Ridout@Brown.edu.
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Ridout
authors.affiliation: Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kole
authors.affiliation: Department of Medical Education, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Fitzgerald
authors.affiliation: Department of Psychiatry and Human Behavior, Mood Disorders Research Program, Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Ridout
authors.affiliation: Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Pediatrics, Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode Island.
authors.forename: Abigail A
authors.initials: AA
authors.lastname: Donaldson
authors.affiliation: Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Pediatrics, Division of Hospitalist Medicine, Hasbro Children's Hospital, Providence, Rhode Island.
authors.forename: Brian
authors.initials: B
authors.lastname: Alverson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001068:Feeding and Eating Disorders / Q000097:blood / Q000191:economics / Q000628:therapy*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D055677:Refeeding Syndrome / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Anorexia nervosa; Bulimia; Eating disorders; Electrolytes; Health care value; Liver function tests; Refeeding syndrome