Introduction Patients with anorexia nervosa (AN) develop significant physical complications leading to emergency admission (EmAd) to acute hospitals. There are few data on national burden, institutional case volume, frequency, nature or outcomes of EmAds for this rare, complex condition. The need for joint management of AN between medical and psychiatric teams has been highlighted 1. We aimed to define characteristics of adult patients with AN admitted as emergencies to acute hospitals in England.
Methods A 2-year download of data for English acute hospitals (Hospital Episode Statistics) was obtained, linked to death registry. We extracted all EmAds in medical or surgical specialties containing ICD-10 codes for AN. Adult patients with a first (index) admission between Oct 07 and Sept 08 were selected (1-year incident cohort). Admissions in 6 months before or after index admission were extracted and ordered chronologically. Demographics and diagnosis codes for each admission were reviewed independently by two gastroenterologists (SL, KB) and a psychiatrist (SS), selecting only cases where 2 of 3 reviewers judged the coding sequence consistent with EmAd for AN. The index EmAd was classified according to primary diagnosis.
Results 549 AN patients were admitted to 132 Trusts in England during the year. Mean age [sd]: 30  yrs; Female: 95.4%; ≥1 Charlson co-morbidities: 11.3%. Primary diagnosis: AN, 33.5%; Complication of AN or a GI symptom, 39.2%; Poisoning or Self Harm, 17.5%; Alcohol-related, 2.4%; Miscellaneous diagnoses, 7.5%. Case load per hospital: One, 18; Two, 20; Three, 24; Four, 21; Five, 17; Six or more cases, 32 hospitals. Length of stay for index admission, mean [sd]: 7.5  days. Re-admissions (within 6 months): None, 53.7%; 1–3, 38.1%; 4+, 8.1%. Range: 36 (0–36) admissions. Total NHS bed days within 6 months of index admission: 7,138. 1 in 5 were not discharged to their usual residence (e.g. transfer to psychiatric unit). Mortality: 2.7% at 30 days; 3.3% at 1 year.
Conclusion Patients with AN are admitted to acute hospitals with a diverse array of physical complications and co-morbidities with high re-admission rates and significant mortality. Annual caseload per hospital varies widely but is mostly very low. This diffuse pattern of care is unlikely to provide the best model for providing high quality care. These unique data should inform the implementation of MARSIPAN and the commissioning of services.
MARSIPAN Group 2010;MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa. Royal College of Psychiatrists and Royal College of Physicians, London
Disclosure of Interest M. Shawihdi: None Declared, E. Thompson: None Declared, S. Sharma Employee of: The Priory Hospital Cheadle Royal, S. Lal: None Declared, M. Pearson: None Declared, K. Bodger Grant/research support from: The Priory Group.