Stephen B Freedman1, Jennifer Thull-Freedman2, David Manson3, Margot Follett Rowe4, Maggie Rumantir2, Mohamed Eltorki5, Suzanne Schuh6. 1. Divisions of Pediatric Emergency Medicine and Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, and Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Faculty of Medicine, University of Toronto, Toronto, ON. Electronic address: stephen.freedman@albertahealthservices.ca. 2. Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, ON. 3. Department of Diagnostic Imaging, Hospital for Sick Children, Division of Pediatric Imaging, Department of Medical Imaging, University of Toronto, Toronto, ON. 4. Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON. 5. Department of Pediatrics, The Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, ON. 6. Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, and Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Faculty of Medicine, University of Toronto, Toronto, ON.
Abstract
OBJECTIVE: To determine the proportion of children diagnosed with constipation assigned a significant alternative diagnosis within 7 days (misdiagnosis), if there is an association between abdominal radiograph (AXR) performance and misdiagnosis, and features that might identify children with misdiagnoses. STUDY DESIGN: We conducted a retrospective cohort study of consecutive children <18 years who presented to a pediatric emergency department in Toronto, between 2008 and 2010. Children assigned an International Statistical Classification of Diseases and Related Health Problems 10th Revision code consistent with constipation were eligible. Misdiagnosis was defined as an alternative diagnosis during the subsequent 7 days that resulted in hospitalization or an outpatient procedure that included a surgical or radiologic intervention. Constipation severity was classified employing text word categorization and the Leech score. RESULTS: 3685 eligible visits were identified. Mean age was 6.6 ± 4.4 years. AXR was performed in 46% (1693/3685). Twenty misdiagnoses (0.5%; 95% CI 0.4, 0.8) were identified (appendicitis [7%], intussusception [2%, bowel obstruction [2%], other [9%]). AXR was performed more frequently in misdiagnosed children (75% vs 46%; P = .01). These children more often had abdominal pain (70% vs 49%; P = .04) and tenderness (60% vs 32%; P =.01). Children in both groups had similar amounts of stool on AXR (P = .38) and mean Leech scores (misdiagnosed = 7.9 ± 3.4; not misdiagnosed = 7.7 ± 2.9; P = .85). CONCLUSIONS: Misdiagnoses in children with constipation are more frequent in those in whom an AXR was performed and those with abdominal pain and tenderness. The performance of an AXR may indicate diagnostic uncertainty; in such cases, the presence of stool on AXR does not rule out an alternative diagnosis.
OBJECTIVE: To determine the proportion of children diagnosed with constipation assigned a significant alternative diagnosis within 7 days (misdiagnosis), if there is an association between abdominal radiograph (AXR) performance and misdiagnosis, and features that might identify children with misdiagnoses. STUDY DESIGN: We conducted a retrospective cohort study of consecutive children <18 years who presented to a pediatric emergency department in Toronto, between 2008 and 2010. Children assigned an International Statistical Classification of Diseases and Related Health Problems 10th Revision code consistent with constipation were eligible. Misdiagnosis was defined as an alternative diagnosis during the subsequent 7 days that resulted in hospitalization or an outpatient procedure that included a surgical or radiologic intervention. Constipation severity was classified employing text word categorization and the Leech score. RESULTS: 3685 eligible visits were identified. Mean age was 6.6 ± 4.4 years. AXR was performed in 46% (1693/3685). Twenty misdiagnoses (0.5%; 95% CI 0.4, 0.8) were identified (appendicitis [7%], intussusception [2%, bowel obstruction [2%], other [9%]). AXR was performed more frequently in misdiagnosed children (75% vs 46%; P = .01). These children more often had abdominal pain (70% vs 49%; P = .04) and tenderness (60% vs 32%; P =.01). Children in both groups had similar amounts of stool on AXR (P = .38) and mean Leech scores (misdiagnosed = 7.9 ± 3.4; not misdiagnosed = 7.7 ± 2.9; P = .85). CONCLUSIONS: Misdiagnoses in children with constipation are more frequent in those in whom an AXR was performed and those with abdominal pain and tenderness. The performance of an AXR may indicate diagnostic uncertainty; in such cases, the presence of stool on AXR does not rule out an alternative diagnosis.
Authors: Gabrielle C Freire; Christina Diong; Sima Gandhi; Natasha Saunders; Mark I Neuman; Stephen B Freedman; Jeremy N Friedman; Eyal Cohen Journal: CMAJ Open Date: 2022-10-11
Authors: Kallie J Hobbs; SallyAnne L DeNotta; Aitor Gallastegui; George L Elane; Luis A Rivero; Pamela Adkins; Diego E Gomez Journal: Can Vet J Date: 2021-08 Impact factor: 1.008