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Child Obes. 2013 Aug;9(4):338-45. doi: 10.1089/chi.2012.0134. Epub 2013 Jun 15.

Acute care costs in overweight children: a pediatric urban cohort study.

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St. Louis Children's Hospital, St. Louis, MO, USA.



Evidence indicates obese children have increased health care utilization. It is unknown if this is true within the emergency department (ED) setting. Our purpose is to determine if overweight children presenting for emergency care have increased resource utilization over normal weight peers.


We conducted a retrospective cohort study of children 2 to <18 years old presenting to a pediatric ED in 2007. Overweight was defined as >95th percentile sex-specific weight-for-age, and normal weight was defined as ≤95(th) percentile. We used a subsample validation to compare these study definitions to BMI-based definitions. We compared total billed charges and secondary outcomes of ED length of stay and admission rate using multivariate and logistic regression models. Outcomes were reported for admitted and discharged patients. Four diagnoses were examined for primary and secondary outcomes.


Of 32,996 included visits, 6333 (19.2%) were for overweight children. Study definitions correctly classified 98.3% of normal weight children but only 51.3% of overweight children. Overweight children were more likely to be older, black, and publicly insured. Median charges for overweight and normal weight children, whether discharged or admitted, were not different in the adjusted model. Admitted overweight children with asthma and fractures or dislocations had higher median charges than normal weight $4617 (2065-375,669) versus $4177 (1980-37,432, p=0.01) and $9855 (6681-58,546) versus $8137 (1461-52,557, p=0.01), respectively.


Overall acute care costs for overweight children are not different from normal weight children. However, admitted overweight children have disease-specific increased use of resources.

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