[An excessive diagnosis of constipation in children complaining of abdominal pain in a pediatric emergency department: an example of practice patterns]. / Une prévalence excessive du diagnostic de constipation chez les enfants consultant pour douleurs abdominales aux urgences: un exemple d'évaluation des pratiques.

ABSTRACT

UNLABELLED Prescriptions of abdominal x-ray and diagnosis of constipation seemed too frequent in children evaluated for abdominal pain (AP) in a paediatric emergency unit. OBJECTIVE: To evaluate the prevalence of constipation in children with AP, to determine clinical and radiological signs related to this diagnosis, and to compare frequencies of clinical criteria of functional chronic constipation (FCC) in children with AP with those of controls (children with mild traumatisms without AP). METHODS: This prospective observational study included children older than 4 years of age consulting for AP. RESULTS: Among 196 patients with AP, 53% had a diagnosis of constipation on discharge (28% isolated and 25% associated with an other diagnosis), and 88% had a plain abdominal x-ray. A faecal retention was considered by emergency practitioners in 92% of children with the diagnosis of constipation vs 22% with other diagnosis (OR=38; CI 95% 15-101). Clinical criteria of FCC were associated with the diagnosis of constipation (OR=2.7; CI 95% 1.4-5.2). A FCC was as prevalent in the control population as in AP population (32 vs 34%). CONCLUSION: An excessive prevalence of diagnosis of constipation was mainly associated with contestable x-ray diagnosis of faecal retention secondary to inappropriate indications of abdominal x-ray.