Delayed Diagnoses in Children with Constipation: Multicenter Retrospective Cohort Study

Stephen B. Freedman, Jonathan Rodean, Matthew Hall, Elizabeth R. Alpern, Paul L. Aronson, Harold K. Simon, Samir S. Shah, Jennifer R. Marin, Eyal Cohen, Rustin B. Morse, Yiannis Katsogridakis, Jay G. Berry, Mark I. Neuman

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)87-94.e16
JournalJournal of Pediatrics
Volume186
DOIs
StatePublished - Jul 1 2017

Fingerprint

Delayed Diagnosis
Constipation
Cohort Studies
Retrospective Studies
Hospital Emergency Service
Antiemetics
Los Angeles
Narcotics
Appendicitis
Diagnostic Errors
Health Care Costs
Comorbidity
Regression Analysis

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Freedman, S. B., Rodean, J., Hall, M., Alpern, E. R., Aronson, P. L., Simon, H. K., ... Neuman, M. I. (2017). Delayed Diagnoses in Children with Constipation: Multicenter Retrospective Cohort Study. Journal of Pediatrics, 186, 87-94.e16. https://doi.org/10.1016/j.jpeds.2017.03.061

Delayed Diagnoses in Children with Constipation : Multicenter Retrospective Cohort Study. / Freedman, Stephen B.; Rodean, Jonathan; Hall, Matthew; Alpern, Elizabeth R.; Aronson, Paul L.; Simon, Harold K.; Shah, Samir S.; Marin, Jennifer R.; Cohen, Eyal; Morse, Rustin B.; Katsogridakis, Yiannis; Berry, Jay G.; Neuman, Mark I.

In: Journal of Pediatrics, Vol. 186, 01.07.2017, p. 87-94.e16.

Research output: Contribution to journalArticle

Freedman, SB, Rodean, J, Hall, M, Alpern, ER, Aronson, PL, Simon, HK, Shah, SS, Marin, JR, Cohen, E, Morse, RB, Katsogridakis, Y, Berry, JG & Neuman, MI 2017, 'Delayed Diagnoses in Children with Constipation: Multicenter Retrospective Cohort Study', Journal of Pediatrics, vol. 186, pp. 87-94.e16. https://doi.org/10.1016/j.jpeds.2017.03.061
Freedman, Stephen B. ; Rodean, Jonathan ; Hall, Matthew ; Alpern, Elizabeth R. ; Aronson, Paul L. ; Simon, Harold K. ; Shah, Samir S. ; Marin, Jennifer R. ; Cohen, Eyal ; Morse, Rustin B. ; Katsogridakis, Yiannis ; Berry, Jay G. ; Neuman, Mark I. / Delayed Diagnoses in Children with Constipation : Multicenter Retrospective Cohort Study. In: Journal of Pediatrics. 2017 ; Vol. 186. pp. 87-94.e16.
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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.",
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T1 - Delayed Diagnoses in Children with Constipation

T2 - Multicenter Retrospective Cohort Study

AU - Freedman, Stephen B.

AU - Rodean, Jonathan

AU - Hall, Matthew

AU - Alpern, Elizabeth R.

AU - Aronson, Paul L.

AU - Simon, Harold K.

AU - Shah, Samir S.

AU - Marin, Jennifer R.

AU - Cohen, Eyal

AU - Morse, Rustin B.

AU - Katsogridakis, Yiannis

AU - Berry, Jay G.

AU - Neuman, Mark I.

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N2 - 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.

AB - 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.

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KW - constipation

KW - diagnostic errors

KW - diagnostic imaging

KW - emergency service

KW - hematologic tests

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