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Related Concept Videos

Assessment of the Rectum and Anus01:25

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Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
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Delayed Diagnoses in Children with Constipation: Multicenter Retrospective Cohort Study.

Stephen B Freedman1, Jonathan Rodean2, Matthew Hall2

  • 1Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.

The Journal of Pediatrics
|May 2, 2017
PubMed
Summary

Abdominal radiographs in children with constipation increase healthcare costs and radiation exposure. These imaging tests are linked to a higher risk of emergency department revisits for important, alternative diagnoses.

Keywords:
abdominalchildconstipationdiagnostic errorsdiagnostic imagingemergency servicehematologic testshospitalradiography

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Area of Science:

  • Pediatric Emergency Medicine
  • Diagnostic Imaging
  • Healthcare Quality Improvement

Background:

  • Abdominal radiographs are frequently used for pediatric constipation but contribute to healthcare costs, radiation exposure, and potential misdiagnoses.
  • The association between abdominal radiograph use and subsequent emergency department (ED) revisits for clinically important alternate diagnoses in children with constipation requires further investigation.

Purpose of the Study:

  • To evaluate the association between abdominal radiograph performance and ED revisits with clinically important alternate diagnoses among children diagnosed with constipation.

Main Methods:

  • A retrospective cohort study analyzed data from children under 18 diagnosed with constipation across 23 EDs between 2004 and 2015.
  • The study examined the primary exposure of abdominal radiograph performance and the primary outcome of a 3-day ED revisit with a clinically important alternate diagnosis, using RAND/UCLA methodology.
  • Regression analysis identified factors independently associated with the primary outcome, including radiograph use, medication administration, and comorbidities.

Main Results:

  • Over 65% of children with constipation received an abdominal radiograph during their initial ED visit.
  • Children who underwent abdominal radiography had a higher likelihood of a 3-day ED revisit for a clinically important alternate diagnosis (0.33% vs. 0.17%).
  • Abdominal radiograph performance remained significantly associated with these revisits after adjusting for covariates (aOR: 1.39; 95% CI 1.15-1.67), with appendicitis being a common alternate diagnosis.

Conclusions:

  • Abdominal radiograph use in pediatric constipation cases is associated with an increased risk of revisits for clinically important alternate diagnoses.
  • This finding suggests a need to reconsider the routine use of abdominal radiographs in managing pediatric constipation to improve patient outcomes and healthcare efficiency.