Malnutrition among Hospitalized Children in the United States: A 2012-2019 Update of Annual Trends

Abstract

Background: Malnutrition is associated with adverse clinical outcomes and increased health care utilization for hospitalized children. Yet pediatric malnutrition often goes undiagnosed and national prevalence research in this population is scarce.

Objective: The aim was to assess change in the coded diagnosis of malnutrition (CDM) among US hospitalized children given increased awareness of the need for improved recognition and standardized diagnosis.

Design: Retrospective, cross-sectional analysis using nationally representative data from the Nationwide Inpatient Sample.

Participants/setting: Our sample was 13.2 million hospitalizations from 2012 to 2019 among pediatric patients between age 1 month and 17 years.

Main outcome measure: CDM using International Classification of Diseases Ninth and 10th Revision-Clinical Modification diagnosis codes.

Statistical analyses: Descriptive statistics and sampling weights were used to estimate the national frequency and prevalence of CDM. Temporal trends in CDM overall and stratified by age, race/ethnicity, and hospital type were analyzed using joinpoint regression.

Results: CDM prevalence increased from 3.9% in 2012 to 6.4% in 2019. During this period, failure to thrive decreased from 40.6% to 23.3% of all cases with concomitant increases in the diagnosis of protein-calorie malnutrition and children identified with more than one malnutrition subtype. Differences in CDM diagnoses are evident by hospital type, race/ethnicity, and age of the patient.

Conclusions: Although pediatric malnutrition continues to be underdiagnosed in hospital settings, this study demonstrates improvement over time. There continues to be a need for continued professional education regarding best practices for diagnosis to improve health care provider knowledge and self-efficacy on this topic, especially in nonteaching hospitals.

Keywords: Coded diagnosis of malnutrition; Continuous quality improvement; HCUP Nationwide Inpatient Sample; Malnutrition Quality Improvement Initiative; Pediatric malnutrition.