The relationship between body mass index and children's presentations to a tertiary pediatric emergency department

Background: The child obesity and its complications are associated with an alarming increased health care use, including the emergency department (ED). We evaluated the effects of the obesity and overweight in children admitted to ED, especially in patients with injury diagnosis. Methods: A retrospective study of patients aged 6-18 years was conducted. Patients were categorized into normal weight (body mass index, BMI < 85th); overweight (BMI ≥ 85th e < 95th); obesity (BMI ≥ 95th). Multiple logistic analysis was used for estimation of risk factors associated with the BMI and to explore the association between injury diagnosis and BMI. Results: The predictive factors associated with obesity and overweight were school age (p < 0.001), male gender (p < 0.001) and number of visits for year (obesity: p < 0.001 and overweight: p < 0.05). Obese children were less at injury risk than normal weight (p < 0.05). In injury subset, fractures in school age were more likely to occur in obesity (p < 0.01). Dislocated fractures (p < 0.01) and fractures at lower extremity were more likely to occur in obesity and overweight (p < 0.05). Conclusions: School age children presenting to ED are more at risk of excess body weight than adolescents and are at higher fracture risk if obese and overweight. This has clear implication to support the efforts to reduce the obesity in childhood. The ED may represent a crucial setting for the early identification of these children and of co-morbidities related BMI ≥ 85th, and for a timely specialist referral of these children, especially if school age.