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J Pediatr. 2017 Jul;186:87-94.e16. doi: 10.1016/j.jpeds.2017.03.061. Epub 2017 Apr 28.

Delayed Diagnoses in Children with Constipation: Multicenter Retrospective Cohort Study.

Author information

1
Sections 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. Electronic address: stephen.freedman@albertahealthservices.ca.
2
Department of Analytics, Children's Hospital Association, Lenexa, KS.
3
Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
4
Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, CT.
5
Division of Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, GA.
6
Divisions of Hospital Medicine and Infectious, Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
7
Departments of Pediatrics and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
8
Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
9
Department of Pediatrics, Children's Health System of Texas, Dallas, TX; Department of Pediatrics, University of Texas Southwestern, Dallas, TX.
10
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
11
Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.

Abstract

OBJECTIVE:

The use of abdominal radiographs contributes to increased healthcare costs, radiation exposure, and potentially to misdiagnoses. We evaluated the association between abdominal radiograph performance and emergency department (ED) revisits with important alternate diagnosis among children with constipation.

STUDY DESIGN:

Retrospective cohort study of children aged <18 years diagnosed with constipation at one of 23 EDs from 2004 to 2015. The primary exposure was abdominal radiograph performance. The primary outcome was a 3-day ED revisit with a clinically important alternate diagnosis. RAND/University of California, Los Angeles methodology was used to define whether the revisit was related to the index visit and due to a clinically important condition other than constipation. Regression analysis was performed to identify exposures independently related to the primary outcome.

RESULTS:

A total of 65.7% (185 439/282 225) of children with constipation had an index ED visit abdominal radiograph performed. Three-day revisits occurred in 3.7% (10 566/282 225) of children, and 0.28% (784/282 225) returned with a clinically important alternate related diagnosis. Appendicitis was the most common such revisit, accounting for 34.1% of all 3-day clinically important related revisits. Children who had an abdominal radiograph performed were more likely to have a 3-day revisit with a clinically important alternate related diagnosis (0.33% vs 0.17%; difference 0.17%; 95% CI 0.13-0.20). Following adjustment for covariates, abdominal radiograph performance was associated with a 3-day revisit with a clinically important alternate diagnosis (aOR: 1.39; 95% CI 1.15-1.67). Additional characteristics associated with the primary outcome included narcotic (aOR: 2.63) and antiemetic (aOR: 2.35) administration and underlying comorbidities (aOR: 2.52).

CONCLUSIONS:

Among children diagnosed with constipation, abdominal radiograph performance is associated with an increased risk of a revisit with a clinically important alternate related diagnosis.

KEYWORDS:

abdominal; child; constipation; diagnostic errors; diagnostic imaging; emergency service; hematologic tests; hospital; radiography

PMID:
28457526
DOI:
10.1016/j.jpeds.2017.03.061
[Indexed for MEDLINE]

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