Reducing Abdominal Radiographs to Diagnose Constipation in the Pediatric Emergency Department

J Pediatr. 2020 Jun 14;S0022-3476(20)30729-0. doi: 10.1016/j.jpeds.2020.06.028. Online ahead of print.

Abstract

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 (ED). Interventions consisted of educational presentations and individualized AXR data reporting. Primary outcome measure was the percentage of AXRs performed on healthy patients discharged home with a diagnosis of constipation before and after QI interventions.

Results: Baseline total percentage of AXRs performed in otherwise healthy children discharged home with a diagnosis of constipation was 36% (October 2016-January 2018). According to questionnaire results, ruling out obstruction was the most common reason for ordering an AXR. Following QI interventions, the total percentage of AXR dropped to 18% (April 2018-March 2019). This 18% decrease was significant (p<0.001) and sustained over a 12-month follow-up period. Throughout the study period, length of stay was on average 1.07 hours longer for children who had an AXR. Clinically important return visits to the ED were uncommon during the post-intervention phase (6.8%, 125/1830), and not associated with whether or not an AXR was performed at the initial visit.

Conclusion: Following QI interventions, we noted a significant and sustained decrease in the percentage of AXRs obtained for otherwise healthy patients discharged home with a diagnosis of constipation.

Keywords: Not in Title: quality improvement; abdominal pain; emergency medicine; pediatrics; radiography.