A Quality Improvement Initiative to Reduce Abdominal X-ray use in Pediatric Patients Presenting with Constipation

McSweeney, Maireade E.; Yuen, Jenny Chan; Meleedy‐Rey, Patricia; Day, Katherine; Nurko, Samuel

doi:10.1016/j.jpeds.2022.07.016

Cited by 6 publications

(7 citation statements)

References 27 publications

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“…Prior reports aiming to reduce unnecessary radiation exposure in children with constipation have focused on decreasing the use of AXR as a diagnostic tool. [6][7][8] These efforts rely on local provider training and education to change ordering behavior in the acute care setting or initial GI clinic visit, citing clinical guidelines that advocate using history and physical examination for diagnosis without the need for AXR. 2,[6][7][8] However, surveys indicate many providers who care for children with chronic constipation may not be aware of the guidelines, and there is still a role for using AXR in the management of chronic constipation.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] These efforts rely on local provider training and education to change ordering behavior in the acute care setting or initial GI clinic visit, citing clinical guidelines that advocate using history and physical examination for diagnosis without the need for AXR. 2,[6][7][8] However, surveys indicate many providers who care for children with chronic constipation may not be aware of the guidelines, and there is still a role for using AXR in the management of chronic constipation. 5,9,10 Our approach to reducing radiation exposures in children with chronic constipation recognizes that while AXRs are still often requested, a dedicated radiology department protocol can lead to a decrease in the number of exposures for each examination by limiting the required exposure area.…”

Section: Discussionmentioning

confidence: 99%

“…5 Previous quality improvement (QI) work to decrease the use of AXRs has focused on changing the examination ordering habits of emergency room providers, pediatricians, and pediatric gastroenterology clinicians for diagnosis of constipation. [6][7][8] There is a role for AXR in monitoring treatment success in children with chronic constipation. For example, at our institution, an international referral center for patients with refractory constipation, children undergo a structured bowel management program.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Decreasing Radiation Exposure to the Abdomen in Children with Chronic Constipation

Chun,

Chmil,

Ruess

2023

Pediatric Quality &Amp; Safety

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Background: Bowel management for children with chronic constipation may include repeated single-view abdomen radiographs (AXR) to monitor treatment success. Only one image of the abdomen is needed to include most of the colon, but technologists often make a second (or even third) exposure to be sure they have imaged the entire abdomen. Our quality improvement project aimed to reduce radiation exposure by decreasing the frequency of >1 exposure performed for AXR orders in children with chronic constipation from 27% to <10% by December 2022 and sustain. Methods: We counted baseline (01/2020–11/2020) and intervention (12/2020–5/2023) examinations with >1 exposure. Initial interventions were a structured communication to technologists and an article in the monthly department newsletter and later, a technologist education module. Additional interventions included communication to radiologists, project updates and encouragement to all technologists, and individual technologist feedback. A statistical process control chart tracked data to study process changes over time. Results: During the baseline and intervention periods, 525/1944 and 1329/8334 examinations, respectively, had >1 exposure performed for AXR orders. Interventions created 2 centerline shifts. Overall, examinations with >1 exposure decreased from 27% to 13.5%. Conclusions: Frequency of >1 exposure performed for AXR orders in children with chronic constipation decreased from 27% to 13.5% through education and communication. This was sustained. We plan to assign training modules for all new technologists, policy reminders (annual training in odd years) for all technologists, and continue individualized learning opportunities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Decreasing Radiation Exposure to the Abdomen in Children with Chronic Constipation

Chun,

Chmil,

Ruess

2023

Pediatric Quality &Amp; Safety

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“…While available data discourage the use of AXR for the evaluation of functional constipation in children due to its limited value, radiation exposure, as well as its possible misleading nature [7][8][9][10][11][12][13][14], a significant number of AXRs continue to be performed on children with constipation, particularly in the emergency department [15][16][17][18]. This has led to quality improvement projects that aim to reduce the number of abdominal X-rays performed in such children, with them showing promising results [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Accuracy of Abdominal X-ray in Childhood Constipation: A Systematic Review of the Literature

Rodriguez,

Dahlwi,

Gould

et al. 2024

Gastrointestinal Disorders

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Background: Previous systematic reviews have found insufficient and conflicting evidence for an association between the clinical and radiographic diagnosis of functional constipation. Abdominal X-ray is frequently used for the diagnosis of functional constipation in clinical practice. The objective of this study was to evaluate the diagnostic accuracy of abdominal X-ray for the evaluation of functional constipation in children. Results: Three studies were included in the final qualitative analysis. They were heterogeneous in their study design, definition of constipation, and radiologic parameters used to evaluate the abdominal X-rays. Sensitivities ranged from 73–92%, specificities ranged from 26–92%, and diagnostic accuracies ranged from 78–90%. Methods: This study involved a systematic review of English literature published between 2012 and 2022 covering children 2–18 years of age with a diagnosis of functional constipation in whom abdominal X-ray was performed. The databases searched include Medline, Embase, and Scopus. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) guidelines were followed. PROSPERO ID: CRD42022301833. Conclusions: There is insufficient evidence to support the use of abdominal X-ray as part of the diagnostic workup of functional constipation. More methodologically rigorous studies are needed to determine the utility of abdominal X-ray in the evaluation of functional constipation. The diagnosis of functional constipation should be based on history and clinical findings.

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Imaging in pediatric disorders of the gut-brain interactions: current best practice and future directions

Rajindrajith,

Hathagoda,

Ganewatte

et al. 2023

Expert Review of Gastroenterology & Hepatology

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A Quality Improvement Initiative to Reduce Abdominal X-ray use in Pediatric Patients Presenting with Constipation

Cited by 6 publications

References 27 publications

Decreasing Radiation Exposure to the Abdomen in Children with Chronic Constipation

Decreasing Radiation Exposure to the Abdomen in Children with Chronic Constipation

The Diagnostic Accuracy of Abdominal X-ray in Childhood Constipation: A Systematic Review of the Literature

Imaging in pediatric disorders of the gut-brain interactions: current best practice and future directions

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