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Predictive factors for short-term symptom persistence in children after emergency department evaluation for
1Room A-216, The Montreal Children's Hospital, 2300 Tupper St, Montreal, Quebec H3H 1P3, Canada. hema.patel@muhc.mcgill.ca
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Most children with constipation visiting the emergency department (ED) improve quickly. However, female sex, recurrent abdominal pain, prolonged symptoms, and prior medical visits are risk factors for poor outcomes in pediatric constipation.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Clinical Outcomes Research
Background:
- Constipation is a common pediatric emergency department (ED) presentation.
- Limited data exist on short-term outcomes for children with constipation post-ED visit.
Purpose of the Study:
- To characterize children presenting to the ED with constipation.
- To assess ED interventions and short-term symptom resolution (48 hours and 7 days).
- To identify predictors of poor symptom resolution.
Main Methods:
- A cohort study of 102 children (aged 1-18) with idiopathic constipation in a tertiary pediatric ED.
- Data collected on symptoms, signs, and ED treatment.
- Telephone follow-up at 48 hours and 7 days to assess symptom resolution.
Main Results:
- Abdominal pain was the predominant symptom (81%); palpable abdominal stool was the most frequent sign (66%).
- High-fiber diet and mineral oil were common ED treatments; enemas were administered to 63%.
- Symptom improvement occurred in 31% at 48 hours and 75% at 7 days. Female sex, recurrent abdominal pain, symptom duration >2 days, and prior medical visits predicted poor resolution.
Conclusions:
- Most children with constipation presenting to the ED experience acute symptoms and rapid improvement.
- Four risk factors consistently predicted poor short-term outcomes, suggesting a need for closer attention in this subgroup.
- Emergency department interventions did not significantly impact short-term symptom resolution.
Background:
Children with symptoms and signs of constipation are commonly assessed in pediatric emergency departments (EDs). Little is known about their outcome following the ED visit.
Objectives:
To describe the clinical characteristics of children presenting to the ED with constipation and the ED interventions; to measure short-term symptom resolution at 48 hours and 7 days after the ED visit; and to identify predictive factors associated with poor symptom resolution at 48 hours and 7 days after the ED visit.
Design/Methods:
Cohort study conducted between July 10, 1997, and September 10, 1997, in a tertiary care pediatric hospital ED. All children (aged 1-18 years) with idiopathic constipation were included. Constipation was diagnosed if there were at least 2 of the following: abdominal pain, infrequent bowel movements, hard feces, fecal soiling, pain on defecation, and/or clinical evidence of excessively retained feces. Data on the presenting symptoms, signs, and ED treatment plan were collected on study enrollment and then in 2 standardized 10-minute telephone interviews at 48 hours and 7 days after the ED visit. At each follow-up, patient disposition was measured and dichotomized based on symptom resolution to "improved" vs "not improved." The presenting features and ED management were compared between groups using chi(2) analyses and t tests.
Results:
Consent and full questionnaire completion was obtained in 102 children. The mean + SD age was 6.5 + 3.8 years; 47 (46%) were male. The predominant presenting symptom was abdominal pain (83 [81%]); the most frequent sign was palpable abdominal stool (67 [66%]). A high-fiber diet (75 [74%]) and mineral oil (48 [47%]) were prescribed most frequently. Enemas were given to 64 (63%) of the children. Improvement was found in 32 (31%) of the children at 48 hours and in the majority at 7 days (77 [75%]). Risk factors for poor symptom resolution at both 48 hours and 1 week included: female sex (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.0 6.6); history of recurrent abdominal pain (OR = 2.8; 95% CI = 1.2-6.5); duration of primary presenting symptom longer than 2 days (OR = 2.4; 95% CI = 1.0-6.4); and history of medical visits for the same symptom (OR = 2.3; 95% CI = 1.0-5.3). There was no difference in outcome based upon ED treatment (enema vs oral or no therapy) (OR = 1.0; 95% CI = 0.4-2.3).
Conclusions:
Most children with constipation evaluated in the ED have acute symptoms and rapid improvement, regardless of presentation characteristics or ED management. In this study, 4 risk factors for poor outcome were found consistently at 48 hours and 7 days. This subgroup of children deserve closer clinical attention. Emergency department therapy did not influence short-term symptom resolution. Further studies are warranted to examine the effects of therapy for constipation in the ED setting. Arch Pediatr Adolesc Med. 2000;154:1204-1208.