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eMediNexus 02 August 2018
The goal of a new study published in Pediatric Emergency Care assessed the use of plain radiographs by pediatric emergency medicine (PEM) providers in the diagnostic evaluation and management of pediatric constipation. This was a cross-sectional survey of PEM providers, wherein survey participants were subscribers to the American Academy of Pediatrics Section on Emergency Medicine Listserv. Participants were presented a case of pediatric constipation meeting Rome III clinical criteria. They were also asked to categorize the frequency of x-ray use, reasons for obtaining, estimated diagnostic utility, and elements of institutional standard approach. Overall, 305 of the Listserv members responded. It was found that 99% of these elected to treat for constipation in patients meeting Rome III clinical criteria, whereas 31% would obtain plain radiographs for a similar case. The value-addition of plain radiographs were viewed as somewhat or minimal in the evaluation of suspected pediatric constipation. Meanwhile, obtaining family acceptance was the most common reason for utilizing plain radiographs. Frequency of x-ray use varied across geographic regions and with participant and hospital characteristics. From the findings, it was inferred that PEM providers obtain radiographs to convince families of the diagnosis of constipation. It was stated that unwarranted use of radiographs is not a viable management plan given the risks of radiation as well as costs.
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