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Pediatric Constipation in the Emergency Department: Evaluation, Treatment, and Outcomes

Freedman, Stephen B.*; Thull-Freedman, Jennifer; Rumantir, Maggie; Eltorki, Mohamed; Schuh, Suzanne

Journal of Pediatric Gastroenterology and Nutrition: September 2014 - Volume 59 - Issue 3 - p 327–333
doi: 10.1097/MPG.0000000000000402
Original Articles: Gastroenterology

Objectives: Limited knowledge exists surrounding the pharmacologic management of pediatric constipation in the emergency department (ED) setting and the success of interventions. Our primary objective was to determine whether enema administration is associated with 7-day ED revisits for persistent symptoms. Secondary objectives focused on assessing other predictors of ED revisits.

Methods: We conducted a retrospective cohort study of children <18 years old, diagnosed as having constipation (International Classification of Diseases-10 codes F98.1 nonorganic encopresis, K59.0 constipation) in a pediatric ED in Toronto, Canada, between November 2008 and October 2010.

Results: A total of 3592 visits were included; 6% (n = 225) were associated with a revisit. Children with revisits more frequently had vomiting (28% vs 17%, P = 0.001), more pain (5.7 ± 3.6 vs 4.6–3.6 of 10, P = 0.01), and underwent more blood tests (19% 05, 11%, 95% confidence interval [CI] of the difference 3%–14%] and diagnostic imaging (62% vs 47%, 95% CI of the difference 9%–22%). Children administered an enema were 1.54 times more likely to revisit the ED than those who did not receive an enema (8.6% vs 5.5%, 95% CI of the difference 1.1%–5.2%, P = 0.001). Type of enema administered varied by age (P < 0.001). Regression analysis identified the following independent predictors of revisits: diagnostic imaging (odds ratio [OR] 1.54, 95% CI 1.15–2.06), vomiting (OR 1.45, 95% CI 1.07–1.98), enema administration (OR 1.40, 95% CI 1.05–1.88), and significant medical history (OR 1.26, 95% CI 1.04–1.53).

Conclusions: Enema administration and diagnostic imaging are associated with revisits in children diagnosed with constipation. Their role in the ED management of pediatric constipation requires further evaluation.

Supplemental Digital Content is available in the text

*Sections of Paediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital Research Institute

Section of Paediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta

Division of Paediatric Emergency Medicine, Department of Paediatrics, Faculty of Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Stephen B. Freedman, MDCM, MSc, Section of Paediatric Emergency Medicine, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta, Canada T3B 6A8 (e-mail:

Received 18 December, 2013

Accepted 9 April, 2014

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

This study was funded in part by The Hospital for Sick Children, Division of Paediatric Emergency Medicine, Research Fund. The writing or preparation of this article was funded in part by the University of Calgary and Alberta Health Services. The study sponsors played no role in study design, data collection, analysis, and interpretation or the writing of the report or the decision to submit the manuscript for publication.

S.B.F. received funding from The Hospital for Sick Children, Division of Paediatric Emergency Medicine, Research Fund, and the University of Calgary, of which he is an employee. The other authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,