Table 1 Studies of inpatient treatment for children and adolescent patients with anorexia nervosa
First Author, Year | # of Participants <18 yrs. (Diagnosis) | Study Design | Mean Length of Stay | Primary Outcome | Findings |
|---|---|---|---|---|---|
Studies of Inpatient Treatment Based on an Integrative Approach for AN | |||||
Anis, 2016 [18] | 59 (47 AN-Ra and 12 atypical ANb) | Case series | 67.2 days (SD=81.1 days) | Change in weight admission to discharge (BMIc) | Weight increased from mean BMI 16.3 (SD=1.35) to 17.1 (SD=1.35) |
Ayton, 2009 [19] | 50 (23 AN-R, 5 AN-B/Pd and 6 EDNOSe) | Case control (outcomes compared between those admitted with parental consent vs those formally detained) | 240 days or 417 days | Change in weight admission to discharge (BMI) | Weight increased from BMI 14.4 (SD=1.9) to 18.5 (SD=1.6) or 16.6 (SD=2.6) to 19.6 (SD=1.5), difference in weight at admission between groups was significant (p=0.001) and non-significant at discharge. |
Bourion-Bedes, 2013 [20] | 66 (54 AN-R and 12 AN-B/P) | Case series | Not reported | Change in weight (BMI) and % of participants reaching 90%TGWf | Admission BMI 14.8 (SD=1.8) and change in BMI 3.1 (SD=1.4) (p<0.001) 90.9% of patients reached 90%TGW by a mean of 58.2 days (SD=38.3) of admission |
Castro-Fornieles, 2007 [21] | 49 (37 AN-R and 12 AN-B/P) | Case series | 29.8 days (SD=17.6) | Change in weight admission to discharge (mean BMI), change mean EAT-26g scores ANSOCQh scores admission to discharge | Weight increased from mean BMI 15.5 (SD=1.4) to 18.4 (SD=0.8) (p<0.001) Mean EAT-26 score decreased from 53.9 (SD=29.9) to 43.5 (SD=29.0) (p=0.002) Mean ANSOCQ score decreased from 53.6 (SD=19.7) to 62.9 (SD=24.5) (p=0.001) |
Fennig, 2015 [36] | 44 (all AN) | Case series | 115.8 days (SD=54.7) | Change in weight admission to discharge (mean BMI), mean EDE-Qi scores, mean EDI-2j scores | Weight increased from mean BMI 16.2 (SD=1.8) at admission to 19.5 (SD=1.5) at discharge Change in total EDE-Q score was significant (p<0.05) No significant change in EDI-2 scores admission to discharge |
Goddard, 2013 [22] | 11 (AN or EDNOS) | Case Series | 29.0 days (SD=11.9) | Change in weight admission to discharge (mean BMI), mean EDE-Q scores | Weight increased from BMI 15.0 (SD=1.6) at admission to 18.5 (SD=1.3) at discharge (p=0.001) EDE-Q total and subscales improved, but non-significant change admission to discharge |
Heinberg, 2003 [23] | 40 (27 AN-R, 8 AN-B/P, 2 “low weight” BN, 1 subthreshold AN-R, 1 subthreshold BNk, 1 atypical ED) | Case control (comparison to adult sample and inpatient to day treatment for adolescent) | 20.6 days (SD=13.03) | Weight gain per week | Rate of inpatient weight gain mean 1.86kg/week (SD=0.68) vs adults gained 1.95 kg/week. Day Treatment weight gain 0.99kg/week (SD=0.47) |
Hetman, 2017 [24] | 51 (44 AN-R, 7 AN-B/P) | Case control (comparison of patients that did not require readmission by one year and those that did require re-admission) | 112 days (SD=69.6) and 113.8 days (SD=34.8) | Weight gain admission to discharge (BMI) and Percent from Target Weight (PFTW) at Discharge, change mean EDE-Q scores admission to discharge | No readmission – increase in BMI from 16.4 (SD=1.8) to 19.6 (SD=1.1) vs readmission – increase in BMI from 16.39 (SD=2.0) to 19.89 (SD=1.19) PFTW in group not requiring readmission was 101.2% at discharge vs 98.2% in group requiring readmission (p<0.05) Change in EDE-Q scores did not differ between groups |
Kalisvaart, 2007 [25] | 39 (28 AN, 11 EDNOS) | Case Series | 50.8 (SD=29.6) | Weight gain admission to discharge (%TGW and BMI) and rate of weight gain | %TGW rose from 74.8 (SD=9.4) at admission to 85.1 (SD=5.3) at discharge (p<0.001) BMI rose from a mean of 15.5 (SD=1.9) to 17.6 (SD=1.2) at discharge (p<0.001) Mean rate of weight gain was 0.1kg/d (SD=0.06) |
Leon, 1985 [26] | 31 (19 AN-R, 12 AN-B/P) | Case Control (AN-R vs AN-B/P) | 143 (Range 56-276) for AN-R group, 135 (Range 43-242) for AN-B/P group | Weight gain (change in weight in kg admission to discharge) | Weight rose from a mean of 38.4kg (range 28.2-47.3) to 47.2kg (37.3-49.5) for AN-R group and from a mean of 42.0kg (35.0-48.6) to 46.8kg (34.1-54.5) |
Lock, 2003 [37] | 39 (all AN) | Case series | 31.9 (SD=16.5) | Weight gain admission to discharge (%TGW) | Mean %TGW rose from 74.9% (SD=7.0%) at admission to 85.2% (SD=5.8%) at discharge |
Lievers, 2009 [27] | 268 (217 AN-R, 51 AN-B/P) | Case series | 135 (SD=97) | Weight gain admission to discharge (BMI) | Mean BMI rose from 13.5 (SD=1.3) at admission to 17.4 (SD=1.4) |
Mekori, 2017 [28] | 88 (44 AN-R, 17 AN-B/P, 13 BN, 14 EDNOS-B/P) | Case control (compared patient with AN vs BN or EDNOS-B/P) | 204 (SD=91) | Weight gain admission to discharge (BMI) | Mean BMI rose significantly from admission to discharge (15.8, SD=1.9 to 19.8, SD=0.7) for AN group. |
Nova, 2008 [29] | 14 (all AN) | Case Series | Unclear | Weight gain admission to one month (%TGW, weight in kg) | Mean %TGW rose from 72.2 (SD=7.9) at admission to 78.7 (SD=6.0) after one month (p<0.001) Mean weight at admission was 39.4 (SD=6.1) and rose to 43.0 (SD=4.9) after one month (p<0.001) |
Rothschild-Yakar, 2011 [30] | 62 (33 AN-R, 10 AN-B/P, 19 BN) | Case control (compared AN-R to AN-B/P and BN combined) | 196.2 (SD=68.1) for AN-R group | Change in mean weight from admission to discharge (BMI) Change in EAT -26 scores admission to discharge | Mean BMI rose from 14.94 (SD=1.93) at admission to 19.24 (SD=1.45) at discharge for AN-R group. Mean EAT-26 score for AN-R group decreased from 41.8 (SD=18.6) to 32.2 (SD=22.2), ES (diagnosis x time = 0.23, NS) |
Roux, 2016 [31] | 83 (all AN) | Case control (compared adolescent to adult patients) | 137.6 (SD=101.8) | Change in weight from admission to discharge (BMI) | Mean BMI rose from 14.3 (SD=1.44) at admission to 17.9 (SD=1.7) at discharge |
Shugar, 1994 [32] | 15 (all AN-B/P) | Case series | 91 (range 84-98) | Change in weight admission to discharge (BMI) Change in EAT-26 score from admission to discharge | Mean BMI rose from 38.4 (SD=2.56) at admission to 16.3 (SD=0.98) at discharge Mean EAT-26 score decreased from 48.7 (SD=9.8) at admission to 29.6 (SD=9.7) at discharge |
Tasaka, 2017 [33] | 41 (all AN-R) | Case series | 130.7 (SD=66.2) | Change in weight admission to discharge (BMI and %TGW) | Mean BMI rose from 13.2 (SD=1.6) at admission to 15.3 (SD=1.7) at discharge Mean %TGW rose from 68.3 (SD=7.3) at admission to 78.8 SD=3.6) at discharge |
Toms, 1972 [34] | 1 (AN) | Case Report | 239 | Change in weight admission to discharge (kg) | Weight increased from 25.5kg at admission to 42.6kg at discharge |
Vall, 2017 [35] | 40 (36 AN-R, 4 AN-B/P) | Case Series | 20.1 (SD=10.3) | Change in weight admission to discharge (BMI centile) Change in EDE-Q score admission to discharge | Mean BMI centile rose from 9.0 (SD=2.1) at admission to 21.3 (SD=3.1) at discharge Mean total EDE-Q score did not differ significantly from admission to discharge |
Stuides Inpatient Treatment Utilizing a Family-Based or Cognitive Behavioural Approach for AN | |||||
Goldfield, 2003 [38] | 1 (AN-R) | Case Report | Not Reported | Change in weight from admission to discharge (BMI) | BMI rose from 15.4 at admission to 19.5 at discharge. |
Halvorsen, 2018 [39] | 37 (all AN) | Case Series | 144.2 (SD=95.2) | Mean change in weight during admission (kg) | Mean weight rose be 7.5kg (SD=4.4) during admission. |
Matthews, 2016 [40] | 1 (AN-R) | Case Report | 9 | Change in weight admission to discharge (BMI and %TGW) | BMI rose from 16.3 at admission to 17.5 at discharge %TGW rose from 82.0% at admission to 85.8% at discharge |
Salbach-Andrae, 2009 [41] | 57 (41 AN-R, 16 AN-B/P) | Case series | 89.6 (SD=24.5) | Change in weight admission to discharge (BMI centile) | Mean BMI centile rose from 1.46 (SD=2.41) at admission to 9.44 (SD=6.68) at discharge |
Schlegl, 2016 [42] | 238 (188 AN-unspecified, 42 AN-B/P, 8 atypical AN) | Case series | 81.9 (32.0) | Change in weight admission to discharge (BMI) Change in EDI-2 scores admission to discharge | Mean BMI rose from 14.8 at admission to 17.3 at discharge (ES=2.06) EDI-2 Global rose from 296.0 (SD=64.3) at admission to 245.7 (SD=65.1) at discharge (ES=0.78) |
Paul, 2013 [43] | 1 (AN-R) | Case report | 6 | Change in weight admission to discharge (kg) | Weight rose from 36.5kg at admission to 37.6kg at discharge |
Studies of Inpatient Treatment Utilizing a Behaviour Therapy Approach for AN | |||||
Alessi, 1989 [44] | 1 (AN-R) | Case Report | 70 | Change in weight admission to discharge (kg) Mean EAT-26 scores admission to discharge | Weight rose from 23.8 kg at admission to 31.8kg at discharge EAT-26 scores remained high until 49 days into admission then decreased (actual absolute values not given) |
Blanchet-Collet, 2016 [45] | 1 (AN-R) | Case Report | Not Reported | Change in weight admission to discharge (BMI) | BMI rose from 13.5 at admission to 16.5 at discharge |
Blinder, 1970 [46] | 1 (AN-R) | Case Report | 38 | Change in weight admission to discharge (kg) | Weight rose from 42.6kg at admission to 51.0kg at discharge |
Cinciripini, 1983 [47] | 1 (AN-B/P) | Case Report | 39 | Change in weight admission to discharge (kg) Change in intake admission to discharge (kcal/day) | Weight rose from 44.0kg at admission to 54.0kg at discharge Daily intake rose from 850kcal at admission to 1700kcal at discharge |
Clark, 1981 [48] | 2 (AN-R) | Case reports | 44 days and 56 days | Change in weight admission to discharge (kg) | Case 1: weight rose from 39.4kg at admission to 45kg at discharge Case 2: weight rose from 39kg to 50kg at discharge |
Collins, 1983 [49] | 37 (AN-R) | Case series | 23.9 (range 2-66) | Weight gain admission to discharge (kg) | Mean weight gain was 5.8kg (range 0-12.7kg) from admission to discharge |
Garfinkel, 1973 [50] | 4 (AN-R) | Case reports | Case 1: 42days Case 2: 42 days Case 3: 56 days Case 4: 21 days | Weight gain while being treated under behavioural therapy framework (kg) | Case 1: 9.0kg Case 2: 8.6kg Case 3: 14.6kg Case 4: 11.9kg |
Halmi, 1975 [51] | 4 (all AN) | Case reports | Not specifically reported for adolescent patients, 43.8 days for adults and adolescents combined | Weight gain admission to discharge (%TGW) Total weight gain during admission (kg) | Mean %TGW at admission was 67.5% and at discharge was 84% Mean total weight gain during admission was 8.15kg |
Leitenberg, 1968 [52] | 2 (both AN) | Case reports | 45 days and 39 days | Weight gain while treated under behavioural therapy framework (kg) Increase in intake while treated under behavioural therapy framework (kcal) | Case 1: weight rose 8.2 kg, intake rose from 1700kcal to 4000kcal Case 2: weight rose 11.2kg, intake rose from 1600kcal to 3900kcal |
Nygaard, 1990 [53] | 84 (all AN) | Case series | 23 (range 7-56) | Weight gain admission to discharge (kg) | Mean weight gain from admission to discharge was 1.89 (SD=1.41) |
Pertschuk, 1978 [54] | 2 (both AN) | Case reports | 13 | Weight gain while treated under behavioural therapy framework (kg) | Case 1: 4.88 kg Case 2: 3.63 kg |
Poole, 1978 [55] | 2 (both AN) | Case reports | 23 | Weight gain while treated under behavioural therapy framework (kg) | Case 1: 12.6 kg Case 2: 15.3 kg |
Solanto, 1994 [56] | 53 (all AN) | Case control (compared 22 vs 31 patients treated under to different behaviour contracts) | 28 | Rate of weight gain when treated under each behaviour contract. | Group 1: 0.09kg/d (SD=0.05) Group 2: 0.16kg/d (SD=0.07) Significant effect for contract x day (p<0.009) |
Steinhausen, 1985 [57] | 24 (17 AN-R, 7 AN-B/P) | Case series | 77 | Weight gain admission to discharge (%TGW) Change in EAT-26 scores admission to discharge Change in EDI-drive for thinness admission to discharge | Mean weight rose from 65.9%TGW at admission to 87.4%TGW at discharge (p<0.0001) Mean EAT-26 score dropped from 37.1 to 12.7 (p<0.0001) Mean EDI-drive for thinness dropped from 8.0 to 1.9 (p<0.02) |
Studies of Inpatient Treatment Utilizing a Psychodynamic Approach for AN | |||||
Groen, 1966 [58] | 5 (all AN) | Case reports | 61 (range 30-91) | Weight gain admission to discharge (kg) | Mean weight rose from 36.6 kg (range 29-43kg) at admission to 43kg (range 36-47kg) at discharge |
Kronenberg, 1994 [59] | 1 (AN-R) | Case report | 152 | Weight gain admission to discharge (kg) | Weight rose from 35kg at admission to 42kg at discharge |
Studies of Inpatient Treatment on Pediatric Unit for AN | |||||
Jenkins, 1987 [60] | 21 (16 AN-R, 5 AN-B/P) | Case series | 185 (SD=122) | Weight gain admission to discharge (%TGW) | Mean %TGW rose from 68% (5.5) at admission to 99% (SD=7.7) at discharge |
Maxmen, 1974 [61] | 5 (all AN) | Case reports | 40 (range 11-67) | Weight gain admission to discharge (kg) | Mean weight rose from 34.4kg at admission to 43.2 at discharge |