In this study, we investigated the density in our regional hospital, the increase in the emergency department, and the financial burden of applications due to constipation. As a result of our study, the majority of applications due to constipation were discharged with various treatments and recommendations. The rate of patients requiring hospitalization was very low. Emergency service applications due to constipation increase both the intensity of the emergency service and the health costs. The use of laxatives reduces recurrent admissions to the emergency department due to constipation.
The lack of a generally accepted definition of constipation is one of the biggest clinical problems. There are some commonly used definitions (for example, Rome III, NASPGHAN, and PAACT), but all suggest different definitions [2, 4, 5]. The definition of constipation varies according to age groups [6]. Since these criteria are not used in emergency services, patients presenting with abdominal pain may be diagnosed with constipation at a high rate or incorrectly. For this reason, it would be more appropriate for constipated patients to use the outpatient clinic instead of the emergency room. In our study, we used history, complaint, and physical examination findings as the criteria for constipation.
Constipation accounts for more than half of abdominal pain. While the use of abdominal X-rays for the diagnosis of constipation in outpatient clinics is 5%, this rate rises to 70% in emergency services [7]. In our study, imaging was performed in 1325 (40.5%) of the patients who applied to the emergency department. This situation causes both a financial burden and unnecessary radiation exposure.
Abdominal X-ray usage is one of the most concerning finding in our study, and 1325 patients (40.5%) had abdominal X-rays. Our findings were lower than the literature [8, 9]. NASPGHAN recommends that the diagnosis has to be based on history and physical examination [4]. A systematic review indicated that abdominal X-ray has poor diagnostic accuracy [10]. On the other hand, Freedman et. al. suggested that using abdominal X-ray may mask underlying conditions [11]. They suggested that the presence of stool on abdominal X-rays does not rule out an alternative diagnosis. In our study, 37 patients (1.14%) were excluded from the study because they were acute appendicitis in addition to constipation. If the presence of stool seen on abdominal X-rays of these patients is not well evaluated, appendicitis would be masked.
Levy et al. found that one-third of children received enema [12]. Approaches of enema are found to be effective in the pediatric population [9]. Also, enema is thought to be discomfortable. According to Freedman et al., children treated with enema visit pediatric emergency departments more than those who do not receive an enema [11]. According to another study, enema and oral laxatives are equally effective for treating fecal impaction in the pediatric population [9]. Enemas relieve rectal pressure and have some impact on a stool throughout the rest of the gastrointestinal tract [8]. In our study, nearly half of the patients received an enema. While the readmission rate of emergency department in only the enema was applied patients was 5.8%, only given IV hydration and only given prescriptions patients’ readmission rate was 20.4%. It can be concluded that the use of laxatives reduces recurrent admissions to the emergency department due to constipation.
These days when the whole world is struggling with epidemics such as the COVID-19 pandemic and natural disasters such as fire and flood, it has become a necessity to use our financial resources and health facilities correctly. The health expenditure for the patients admitted to our pediatric emergency department due to constipation for a period of 1 year is ₺834.626. Although this amount seems small, it reaches a level that cannot be underestimated when the whole country is taken into account. This workforce and financial resource can use for the worse patients.
