ME McSweeney et al. J Pediatr 2022; 251: 127-133. A Quality Improvement Initiative to Reduce Abdominal X-ray use in Pediatric Patients Presenting with Constipation

Key findings:

• In total, 6723 patients completed new patient gastroenterology visits for a primary diagnosis of constipation between 2013 and 2019. Of these, 993 (14.8%) patients had abdominal radiographs taken within 24 hours of their initial visit. Over the 7 years of this project, a mean frequency of abdominal radiograph use decreased from 24% to less than 11%.
•  No increases in subsequent emergency department visits or hospitalization for constipation within 30 days of patients’ initial visits were seen.
• One of the keys to improvement was providing data to individual providers

The authors note that routine radiographs are NOT recommended by expert guidelines in patients presenting with functional constipation.

My take: The trend of using radiographs less frequently shows that a QI project can help avoid low value testing though more than 10% is still too high.

Related blog posts:

• Constipation Action Plan: Better Instructions, Fewer Phone Calls
• Pictographic Constipation Action Plan
• Improving ER Performance for Suspected Constipation
• What’s Wrong with Ordering an AXR for Constipation in the ER?
• Updated Pediatric Expert Constipation Guidelines | gutsandgrowth
• Don’t Let the Chief of Staff Review This Constipation Study
• Is the Rectal Exam Obsolete?
• Diagnosis and Misdiagnosis of Constipation
• Stimulants for constipation
• Diagnostic tests hardly ever help patients poop
• How to Rectify the Problem of Missed Impactions