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Incidence, clinical presentation, and management of constipation in a pediatric ED
Antonella Diamanti1, Fiammetta Bracci, Antonino Reale
1Gastroenterology and Nutrition Unit, "Bambino Gesù" Children's Hospital, 00165 Rome, Italy.
Insights
Functional constipation (FC) affects 0.4% of pediatric emergency department (ED) visits. ED physicians play a key role in diagnosing FC and initiating treatment, preventing potential complications.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Clinical Epidemiology
Background:
- Functional constipation (FC) is a common pediatric condition.
- Emergency departments (EDs) manage a significant number of pediatric cases.
- Understanding ED presentation and management of FC is crucial.
Purpose of the Study:
- To determine the incidence of pediatric functional constipation visits to the ED.
- To analyze the clinical presentation and physician management of FC in the ED.
- To assess referral patterns post-ED discharge.
Main Methods:
- Retrospective study of 202 pediatric patients (<15 years) diagnosed with FC.
- Analysis of hospital records from an Italian children's hospital ED over one year.
- Evaluation of incidence, demographics, symptoms, and physician interventions.
Main Results:
- FC accounted for 0.4% of total ED consultations.
- Younger children (≤4 years) were more frequently diagnosed with FC.
- Key symptoms included infrequent bowel movements, abdominal pain, and stool retention.
- Most patients initiated new therapy post-ED discharge and were referred to community pediatricians.
Conclusions:
- ED physicians are vital in diagnosing and managing pediatric FC.
- ED interventions facilitate therapeutic strategies and prevent complications.
- Despite low incidence, FC requires significant ED attention and appropriate referral pathways.
Objectives:
The study aimed to assess, in pediatric patients presenting to the emergency department (ED), the incidence of visit to the ED for functional constipation (FC), symptoms, signs of presentation, and management from ED physicians.
Design:
This is a retrospective study of hospital records for a period of 1 year at the ED of "Bambino Gesù" Children's Hospital, Rome, Italy. Children younger than 15 years discharged from ED with a diagnosis of FC in the 1-year period were included.
Interventions:
We analyzed medical records of 202 patients (<15 years) with FC diagnosis at discharge. Main outcome measures included incidence, demographic characteristics, clinical presentations of FC patients, and ED physicians' interventions.
Results:
Two hundred two FC cases were studied in a 12-month study period. Compared with the total number of ED consultations, the incidence of FC was 0.4%. The number of patients 4 years or younger was much higher than patients older than 4 years (P < .0001). Bowel frequency of 3 bowel movements or less per day, acute abdominal pain, and stool retention were found to be significantly more frequent than the other presenting symptoms (P < .0001). The number of patients beginning a therapy after ED discharge was significantly higher compared with that already treated before ED visit (P < .0001). Discharged patients were referred to community pediatricians significantly more frequently than to pediatric gastroenterologists (P = .003).
Conclusions:
Emergency department physicians have an important role in the diagnosis and management of FC despite its relatively low incidence. Indeed, ED intervention in many cases leads not only to recognition this disease but also to an approach for therapeutic strategy, avoiding complications of chronic constipation.
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