Evidence lacking in using radiography to diagnose constipation in children

Abdominal radiographs have been used to diagnose functional constipation in children and adolescents, despite a lack of evidence showing reliability. Researchers from the Boston Children’s Hospital examined how gastroenterologists use the images in diagnosing young patients.

The prospective study, led by Beate Beinvogl, MD, was published in the Dec. 2017 issue of the Journal of Pediatrics. The team surveyed a total of 24 providers after 72 patient encounters.

The abdominal radiographs were ordered for stool burden (70 percent), need for a cleaning (35 percent), fecal impaction (27 percent), cause of abdominal pain (24 percent), demonstration of stool burden to families (14 percent), assessment of response to therapy (13 percent) or encopresis (10 percent).

The gastroenterologists reported plans were changed 47.6 percent of cases based on radiographic findings. In cases with a plan before the image (69 percent), the initial plan was implemented 52.5 percent of the time.

“Abdominal radiographs commonly are obtained by pediatric gastroenterologists in the evaluation and management of constipation,” wrote Beinvogl et al. “The majority used it to make a diagnosis, and nearly one-half changed their management based on the imaging findings. Overall, they reported an improved confidence in their management plan, despite evidence that radiographic findings poorly correlate with clinical severity.”

The researchers encouraged further investigation regarding the recommendations associated with radiography in diagnosing constipation.