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

Area of Science:

• Pediatric Emergency Medicine
• Gastroenterology
• Healthcare Quality Improvement

Background:

• Constipation is a prevalent condition in pediatric emergency departments (PEDs), affecting 0.7-30% globally.
• Existing guidelines recommend against routine imaging for pediatric constipation evaluation.
• Significant practice variations exist in how different provider types manage pediatric constipation.

Purpose of the Study:

• To analyze practice trends in the evaluation and treatment of pediatric constipation.
• To compare management strategies among Emergency Physicians (EPs), Advanced Practice Providers (APPs), and residents.
• To identify variations in imaging use and medication choices based on provider type.

Main Methods:

• A 3-year retrospective chart review of pediatric emergency department visits for constipation.
• Analysis of International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes for constipation discharge diagnoses.
• Evaluation of imaging modalities (X-ray, ultrasound, CT) and medication choices utilized.

Main Results:

• Out of 6698 patients, 4515 were included; 76% received X-rays, 17% ultrasound, and 3.7% CT scans.
• The EP + APP group ordered more abdominal X-rays (AXR) and CT scans compared to other groups.
• Provider differences were noted across hospital sites, with specific medication preferences observed (e.g., laxatives, stool softeners).

Conclusions:

• Practice patterns for pediatric constipation management differ significantly based on provider type, particularly in imaging utilization.
• The EP + APP group demonstrated higher rates of AXR and CT scan orders.
• Standardized management guidelines are recommended to minimize practice variability and improve care consistency.