ConstiPatED: Evaluation in the pediatric ED - practice pattern and trends amongst provider types

Constipation is a common problem encountered in pediatric emergency department (PED), with a global prevalence ranging from 0.7 to 30 %. Guidelines discourage the use of imaging in evaluation of pediatric constipation. This study aimed to describe practice trends by provider type: Emergency physicians (EP), advanced practice providers (APPs) and residents- for evaluation and treatment of pediatric constipation.

3-year retrospective chart review was conducted using electronic medical record based of ED visits with International Statistical Classification of Diseases and Related Health Problems (ICD) -10 codes for discharge diagnosis of constipation across three hospitals locations within a specific healthcare network with a mix of academic and community hospitals. The use of imaging modalities and medication choices were analyzed.

Of 6698 patients with discharge diagnosis of constipation, 4515 formed the final cohort. Imaging was common with 76 % receiving X-Rays, 17 % ultrasound, and 3.7 % abdominal computerized tomography, the EP + APP group ordered more AXR (OR = 1.18) and CT scans (Adjusted OR = 1.20); the treatment regimen showed that the EP + Residents ordered more analgesics. The EP + AAPs combination ordered oral medications such as laxative and stool softeners (OR = 1.46). Provider differences amongst sites were identified.

Practice patterns varied by provider, with frequent imaging use, with a larger use by the EP + APP group. Establishing standardized guidelines for management of constipation may reduce variability. Further research is needed to clarify the type of enemas and optimal laxative regimen.