Emergency department management and short-term outcome of children with constipation.
BACKGROUND
Constipation is a common diagnosis made in the pediatric emergency department (ED). Specific evidence-based standards for evaluation and treatment are lacking.


OBJECTIVE
To describe variation in evaluation and treatment of constipation and characteristics and treatments associated with improvement.


METHODS
This single-site descriptive study examined constipated children discharged from the ED. Chart review provided history, examination, evaluation, and treatment. Symptoms and on-going treatment were assessed by telephone interview at 4 to 6 weeks. Patients were dichotomized to poor versus adequate responders. Poor responders had 2 or more of the following: overall constipation, persistent presenting symptom, bowel movement frequency of less than once every other day, painful defecation, and/or abdominal pain.


RESULTS
The study group had 121 patients, with mean age of 6.4 years; 54% were female. Abdominal pain was the most common complaint (66%); 46% reported hard/infrequent stools. Most (67%) had symptoms for less than 1 week. Many (41%) previously sought care for the same problem. Most (70%) had abdominal radiographs. One third received an enema in the ED, and most patients were prescribed laxatives, most commonly polyethylene glycol (80%). After an enema, 28% were discharged without constipation medication. At follow-up, 35% were using laxatives, and 27% had sought additional care. Nearly half (42%) were poor responders. Poor responders were younger (5.1 vs. 7.3 years; P < 0.01). There was no difference in response based upon sex, duration of symptoms, or ED treatment.


CONCLUSIONS
Although older children are more likely to improve, many constipated children continue to have symptoms. Type of ED therapy is unrelated to on-going symptoms at 4 to 6 weeks.
Miller
Melissa K
MK
Division of Emergency Medicine, Children's Mercy Hospital, Kansas City, MO 64108, USA. mmiller@cmh.edu
Dowd
M Denise
MD
Fraker
Megan
M
D016009:Chi-Square Distribution; D002648:Child; D003248:Constipation / Q000175:diagnosis* / Q000628:therapy*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome