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Constipation and paediatric emergency department utilization

Alison Nutter1, Garth Meckler1, Mimi Truong1

  • 1Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia.

Paediatrics & Child Health
|February 27, 2018
PubMed

Insights

Pediatric constipation often leads to unnecessary emergency department (ED) visits. Many children receive excessive imaging and treatments, with underutilization of outpatient care, suggesting a need for improved constipation management strategies.

Area of Science:

  • Pediatric Gastroenterology
  • Emergency Medicine
  • Healthcare Utilization

Background:

  • Constipation is a prevalent condition among children.
  • Limited data exists on the acute healthcare use of constipated children, particularly their emergency department (ED) visits, presenting complaints, and treatments.

Purpose of the Study:

  • To investigate the characteristics of pediatric constipation-related emergency department (ED) visits.
  • To analyze the spectrum of presenting complaints, diagnostic investigations, and therapeutic interventions used in the ED for pediatric constipation.
  • To evaluate the efficiency of ED flow and patient disposition for constipation cases.

Main Methods:

  • A cross-sectional chart review was conducted at British Columbia Children's Hospital ED.
  • Data from 42,875 ED visits between August 31, 2012, and September 1, 2013, were assessed.
  • 913 patients with a potential constipation diagnosis were included, recording chief complaints, tests, therapies, waiting times (WT), and length of stay (LOS).

Main Results:

  • Constipation accounted for 2.1% of all ED visits.
  • Abdominal pain was the most common complaint (65.6%), but 11.9% presented with non-gastrointestinal issues.
  • Nearly one-third of patients had abdominal radiographs, and almost half received fleet enemas; only 25% were discharged with long-term management plans.
  • ED flow measures (WT, LOS) showed no significant differences between patient groups.

Conclusions:

  • Many pediatric constipation cases do not require emergency department (ED) intervention and can be managed effectively as outpatients.
  • The study highlights the overuse of diagnostic imaging and invasive ED treatments.
  • There is an underutilization of outpatient medication and dietary counseling, potentially leading to recurrent ED visits.
Abstract

Keywords:
ConstipationERFlowInvestigationsTreatmentUnnecessary

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