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Reducing Abdominal Radiographs to Diagnose Constipation in the Pediatric Emergency Department
Gabriela Moriel1, Theresa Tran1, Phung K Pham2
1Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
Insights
Quality improvement interventions significantly reduced abdominal radiographs for diagnosing constipation in children, decreasing their use from 36% to 18% without impacting return visits.
Area of Science:
- Pediatric Emergency Medicine
- Radiology Quality Improvement
- Clinical Practice Guidelines
Background:
- Abdominal radiographs are frequently used in pediatric emergency departments to diagnose constipation in children.
- The utility and necessity of routine abdominal radiographs for constipation in otherwise healthy children are debated.
- Overutilization of imaging can lead to increased healthcare costs and radiation exposure.
Purpose of the Study:
- To determine the frequency of abdominal radiographs in healthy children diagnosed with constipation.
- To evaluate the impact of quality improvement (QI) interventions on the use of abdominal radiographs for constipation in a pediatric emergency department.
Main Methods:
- A 2.5-year QI study was conducted at a quaternary care children's hospital emergency department.
- Interventions included educational presentations and individualized radiograph data reporting.
- The primary outcome was the percentage of abdominal radiographs performed on healthy children discharged with constipation before and after QI interventions.
Main Results:
- Baseline abdominal radiograph use for constipation was 36% (Oct 2016-Jan 2018).
- Following QI interventions, radiograph use decreased significantly to 18% (Apr 2018-Mar 2019), a sustained 18% reduction (P < .001).
- Children undergoing radiography had a 1.07-hour longer average length of stay; return visits were infrequent and not associated with radiography use.
Conclusions:
- QI interventions led to a significant and sustained decrease in abdominal radiographs for pediatric constipation.
- Reducing unnecessary imaging is feasible and can be achieved through targeted QI efforts.
- Further research should focus on non-radiographic diagnostic pathways for constipation in children.
Objective:
To determine the frequency of abdominal radiographs obtained in healthy children aged 6 months to 18 years to diagnose constipation in a pediatric emergency department, and evaluate the impact of quality improvement (QI) interventions on their use.
Study Design:
QI study over 2.5 years at a large urban quaternary care children's hospital emergency department. Interventions consisted of educational presentations and individualized abdominal radiograph data reporting. The primary outcome measure was the percentage of abdominal radiographs performed on healthy patients discharged home with a diagnosis of constipation before and after QI interventions.
Results:
The baseline total percentage of abdominal radiographs performed in otherwise healthy children discharged home with a diagnosis of constipation was 36% (October 2016 to January 2018). According to questionnaire results, ruling out obstruction was the most common reason for ordering an abdominal radiograph. After the QI interventions, the total percentage of abdominal radiograph decreased to 18% (April 2018 to March 2019). This 18% decrease was significant (P < .001) and sustained over a 12-month follow-up period. Throughout the study period, the average length of stay was 1.07 hours longer for children who had an abdominal radiograph. Clinically important return visits to the emergency department were uncommon during the postintervention phase (125/1830 [6.8%]), and not associated with whether or not an abdominal radiograph was performed at the initial visit.
Conclusion:
After these QI interventions, we noted a significant and sustained decrease in the percentage of abdominal radiographs obtained for otherwise healthy patients discharged home with a diagnosis of constipation.
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