F. Bruder Stapleton, MD reviewing Freedman SB et al. J Pediatr 2017 Apr 28.
Obtaining abdominal radiographs to evaluate constipation in children is associated with increased risk of return emergency room visits for a serious related condition, most often appendicitis.
Although abdominal imaging is not recommended for the evaluation of children with constipation, with or without abdominal pain, clinical practice is quite variable. In a retrospective cohort study of children who presented to 23 emergency departments (EDs) for constipation, impaction, or encopresis from 2004 to 2015, researchers assessed whether obtaining an abdominal radiograph was associated with revisit to the ED with a clinically important alternate related diagnosis.
Of roughly 230,000 children, 66% underwent abdominal radiography at the index visit and 0.28% returned to an ED and received a clinically important alternate related diagnosis within 3 days. Appendicitis accounted for 34% of these revisits. Children who underwent abdominal radiography at the index visit, compared with those who did not, were significantly more likely to revisit the ED within 3 days (4.0% vs. 3.3%) and to receive a clinically important alternate related diagnosis (0.33% vs. 0.17%). In adjusted analyses, abdominal radiography at the index visit was independently associated with a revisit with an important alternate diagnosis within 3 days (OR, 1.40). Other factors independently associated with this outcome were administration of narcotics or antiemetics, performance of complete blood count, and presence of associated comorbidities. Findings were similar for revisits within 7 and 30 days.
Freedman SB et al. Delayed diagnoses in children with constipation: Multicenter retrospective cohort study. J Pediatr 2017 Apr 28; [e-pub].