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Abdominal Radiographs in the Management of Pediatric Constipation.

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eMediNexus    29 December 2017

A new study published in The Journal of Pediatrics aimed to identify the reasons behind obtaining abdominal radiographs pediatric gastroenterologists for the management of pediatric constipation. This prospective study surveyed providers regarding their rationale, interpretation, resultant change, and confidence in their management before and after obtaining kidney, ureter, bladder X-rays (KUBs) in patients evaluated for suspected constipation. Here, overall 24 providers were surveyed after 72 patient encounters. The findings revealed that the reasons for obtaining an abdominal radiograph included evaluation of stool burden (70%), need for a clean-out (35%), fecal impaction (27%), cause of abdominal pain (24%), demonstration of stool burden to families (14%), assessment of response to therapy (13%), or encopresis (10%). It was also noted that the treatment plan was modified in 47.6% of cases based on radiographic findings. On the other hand, among cases where treatment was already planned before obtaining the radiograph (69%), the initial plan was implemented on an average of 52.5%. Whereas, in cases where the treatment plan was not decided upon before obtaining the radiograph, prior unconsidered plans were implemented in 8.7%. Moreover, provider confidence in the management plan increased from 2.4 ± 2.7 to 4.1 ± 1.8 after the abdominal radiograph. Therefore, it was inferred that abdominal radiographs are commonly obtained by pediatric gastroenterologists for the evaluation and management of constipation. A majority of these physicians used it for diagnosis, while nearly one-half changed their management based on the imaging findings. Overall, they reported an improved confidence in their management plan, despite evidence that radiographic findings poorly correlate with clinical severity.

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