The American journal of emergency medicine · 2025
ConstiPatED: Evaluation in the pediatric ED - practice pattern and trends amongst provider types.
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Krishnaprasadh Dharshana, Samberg Margaret J, Fawaz Lara, Grant Sara, Menoch Margaret
Аннотация
BACKGROUND: Constipation is a common problem encountered in pediatric emergency department (PED), with a global prevalence ranging from 0.7 to 30 %. Guidelines discourage the use of imaging in evaluation of pediatric constipation. This study aimed to describe practice trends by provider type: Emergency physicians (EP), advanced practice providers (APPs) and residents- for evaluation and treatment of pediatric constipation.
METHODS: 3-year retrospective chart review was conducted using electronic medical record based of ED visits with International Statistical Classification of Diseases and Related Health Problems (ICD) -10 codes for discharge diagnosis of constipation across three hospitals locations within a specific healthcare network with a mix of academic and community hospitals. The use of imaging modalities and medication choices were analyzed.
RESULTS: Of 6698 patients with discharge diagnosis of constipation, 4515 formed the final cohort. Imaging was common with 76 % receiving X-Rays, 17 % ultrasound, and 3.7 % abdominal computerized tomography, the EP + APP group ordered more AXR (OR = 1.18) and CT scans (Adjusted OR = 1.20); the treatment regimen showed that the EP + Residents ordered more analgesics. The EP + AAPs combination ordered oral medications such as laxative and stool softeners (OR = 1.46). Provider differences amongst sites were identified.
CONCLUSIONS: Practice patterns varied by provider, with frequent imaging use, with a larger use by the EP + APP group. Establishing standardized guidelines for management of constipation may reduce variability. Further research is needed to clarify the type of enemas and optimal laxative regimen.
METHODS: 3-year retrospective chart review was conducted using electronic medical record based of ED visits with International Statistical Classification of Diseases and Related Health Problems (ICD) -10 codes for discharge diagnosis of constipation across three hospitals locations within a specific healthcare network with a mix of academic and community hospitals. The use of imaging modalities and medication choices were analyzed.
RESULTS: Of 6698 patients with discharge diagnosis of constipation, 4515 formed the final cohort. Imaging was common with 76 % receiving X-Rays, 17 % ultrasound, and 3.7 % abdominal computerized tomography, the EP + APP group ordered more AXR (OR = 1.18) and CT scans (Adjusted OR = 1.20); the treatment regimen showed that the EP + Residents ordered more analgesics. The EP + AAPs combination ordered oral medications such as laxative and stool softeners (OR = 1.46). Provider differences amongst sites were identified.
CONCLUSIONS: Practice patterns varied by provider, with frequent imaging use, with a larger use by the EP + APP group. Establishing standardized guidelines for management of constipation may reduce variability. Further research is needed to clarify the type of enemas and optimal laxative regimen.