Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Department of Analytics, Children's Hospital Association, Lenexa, KS.
J Pediatr. 2017 Jul;186:87-94.e16. doi: 10.1016/j.jpeds.2017.03.061. Epub 2017 Apr 28.
The use of abdominal radiographs contributes to increased healthcare costs, radiation exposure, and potentially to misdiagnoses. We evaluated the association between abdominal radiograph performance and emergency department (ED) revisits with important alternate diagnosis among children with constipation.
Retrospective cohort study of children aged <18 years diagnosed with constipation at one of 23 EDs from 2004 to 2015. The primary exposure was abdominal radiograph performance. The primary outcome was a 3-day ED revisit with a clinically important alternate diagnosis. RAND/University of California, Los Angeles methodology was used to define whether the revisit was related to the index visit and due to a clinically important condition other than constipation. Regression analysis was performed to identify exposures independently related to the primary outcome.
A total of 65.7% (185 439/282 225) of children with constipation had an index ED visit abdominal radiograph performed. Three-day revisits occurred in 3.7% (10 566/282 225) of children, and 0.28% (784/282 225) returned with a clinically important alternate related diagnosis. Appendicitis was the most common such revisit, accounting for 34.1% of all 3-day clinically important related revisits. Children who had an abdominal radiograph performed were more likely to have a 3-day revisit with a clinically important alternate related diagnosis (0.33% vs 0.17%; difference 0.17%; 95% CI 0.13-0.20). Following adjustment for covariates, abdominal radiograph performance was associated with a 3-day revisit with a clinically important alternate diagnosis (aOR: 1.39; 95% CI 1.15-1.67). Additional characteristics associated with the primary outcome included narcotic (aOR: 2.63) and antiemetic (aOR: 2.35) administration and underlying comorbidities (aOR: 2.52).
Among children diagnosed with constipation, abdominal radiograph performance is associated with an increased risk of a revisit with a clinically important alternate related diagnosis.
腹部 X 光片的使用会增加医疗保健成本、辐射暴露，并且可能导致误诊。我们评估了腹部 X 光片的表现与急诊（ED）就诊的重要替代诊断之间的关联，这些替代诊断是患有便秘的儿童中存在的。
这是一项回顾性队列研究，纳入了 2004 年至 2015 年期间在 23 家 ED 就诊的年龄<18 岁的便秘患儿。主要暴露是腹部 X 光片的表现。主要结局是 3 天内因临床重要的其他诊断而 ED 复诊。使用 RAND/加州大学洛杉矶分校的方法来确定复诊是否与就诊有关，以及是否由于除便秘以外的临床重要情况导致。进行回归分析以确定与主要结局独立相关的暴露因素。
共有 65.7%（185/439）的便秘患儿在 ED 就诊时进行了腹部 X 光检查。3 天内复诊的患儿有 3.7%（10/566），0.28%（784/282225）因临床重要的其他相关诊断而复诊。阑尾炎是最常见的这种复诊，占所有 3 天内临床重要相关复诊的 34.1%。进行腹部 X 光检查的患儿更有可能在 3 天内因临床重要的其他相关诊断而复诊（0.33%比 0.17%；差异 0.17%；95%CI 0.13-0.20）。在校正了混杂因素后，腹部 X 光检查与 3 天内因临床重要的其他相关诊断而复诊相关（aOR：1.39；95%CI 1.15-1.67）。与主要结局相关的其他特征包括使用阿片类药物（aOR：2.63）和止吐药（aOR：2.35）以及潜在合并症（aOR：2.52）。
在诊断为便秘的儿童中，腹部 X 光片的表现与临床重要的其他相关诊断的复诊风险增加相关。
