title: Pediatric constipation in the emergency department: evaluation, treatment, and outcomes.
abstract: OBJECTIVE
  Limited knowledge exists surrounding the pharmacologic management of pediatric constipation in the emergency department (ED) setting and the success of interventions. Our primary objective was to determine whether enema administration is associated with 7-day ED revisits for persistent symptoms. Secondary objectives focused on assessing other predictors of ED revisits.
  
  
  METHODS
  We conducted a retrospective cohort study of children <18 years old, diagnosed as having constipation (International Classification of Diseases-10 codes F98.1 nonorganic encopresis, K59.0 constipation) in a pediatric ED in Toronto, Canada, between November 2008 and October 2010.
  
  
  RESULTS
  A total of 3592 visits were included; 6% (n = 225) were associated with a revisit. Children with revisits more frequently had vomiting (28% vs 17%, P = 0.001), more pain (5.7 ± 3.6 vs 4.6-3.6 of 10, P = 0.01), and underwent more blood tests (19% 05, 11%, 95% confidence interval [CI] of the difference 3%-14%] and diagnostic imaging (62% vs 47%, 95% CI of the difference 9%-22%). Children administered an enema were 1.54 times more likely to revisit the ED than those who did not receive an enema (8.6% vs 5.5%, 95% CI of the difference 1.1%-5.2%, P = 0.001). Type of enema administered varied by age (P < 0.001). Regression analysis identified the following independent predictors of revisits: diagnostic imaging (odds ratio [OR] 1.54, 95% CI 1.15-2.06), vomiting (OR 1.45, 95% CI 1.07-1.98), enema administration (OR 1.40, 95% CI 1.05-1.88), and significant medical history (OR 1.26, 95% CI 1.04-1.53).
  
  
  CONCLUSIONS
  Enema administration and diagnostic imaging are associated with revisits in children diagnosed with constipation. Their role in the ED management of pediatric constipation requires further evaluation.
authors.affiliation: *Sections of Paediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital Research Institute †Section of Paediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta ‡Division of Paediatric Emergency Medicine, Department of Paediatrics, Faculty of Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Thull-Freedman
authors.forename: Maggie
authors.initials: M
authors.lastname: Rumantir
authors.forename: Mohamed
authors.initials: M
authors.lastname: Eltorki
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuh
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D019343:Citric Acid / Q000627:therapeutic use; D003248:Constipation / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004733:Enema; D005260:Female; D006403:Hematologic Tests / Q000706:statistics & numerical data; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008277:Magnesium Oxide / Q000627:therapeutic use; D008297:Male; D010351:Patient Discharge; D010847:Picolines / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011859:Radiography; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
chemical_list: D054368:Laxatives; C574900:Pico-Salax; D010847:Picolines; D019343:Citric Acid; D008277:Magnesium Oxide; D011092:Polyethylene Glycols