Academic Emergency Medicine
Background and Objectives: Constipation is a very common problem encountered in the pediatric emergency department (PED). Evidence based guidelines discourage the use of abdominal radiography or other imaging modalities in routine evaluation of children. However, AXR were more commonly obtained if symptoms or abdominal pain and emesis were noted. After current literature review, a little is known about practice pattern variation by provider type in the management of constipation. The aim of this study is to describe current practice trends by provider type: Pediatric Emergency Medicine (PEM), Emergency Medicine (EM), Mid-Level Providers (MLP) and resident/fellows for evaluation and treatment of pediatric constipation across Beaumont Emergency Departments (ED). Methods: This is a retrospective chart review of electronic medical record based of ED visits with ICD -10 codes for discharge diagnosis of constipation. Children between ages 6 months to 17 years from September 2017 to June 2020 were included in the study. Three hospitals locations (Site 1, 2, 3) within a specific healthcare network were analyzed. One hospital has PEM fellowship trained faculty and other centers staffed with EM faculty. Residents and MLP (including Physician Assistants & Nurse Practitioners) are presents at all sites. No treatment protocol for management of constipation exists at any of the sites. Practice pattern variation amongst PEM & EM were compared for imaging and medication ordered during the ED visit. Results: In total, 4627 patients met inclusion criteria. Patient encounters by physician type include: 2538 (54.8%) seen by EM, 2089 (45.1%) by PEM, 1801(38.9%) by MLP and 2826(61.0%) by resident providers. Imaging in ED was very common: 3523 abdominal radiographs (AXR) were done; 78.8% by EM providers, 72.9% by PEM providers, 41.9% by MLP, 58% by residents. The most common treatment administered for constipation was laxative (1496 times); 23.3% by EM, 43.3% by PEM, 19.5% by MLP and 40.5% by residents. Comparison analysis is on-going for this data. Conclusion: Preliminary data analysis show that abdominal radiographs were frequently done in the diagnosis of constipation, regardless of the provider type and the AXR ordering trends exponentially reduced (logarithmic distribution) during study time period. The two most common treatments administered for constipation was laxative and enema.
Krishnaprasadh D, Menoch M, Samberg M, Fawaz L, Grant S. Pediatric constipation evaluation in the emergency department practice patterns and trends amongst provider types. Acad Emerg Med. 2021 May;28(suppl 1):S70.