Things We Do for No Reason™: Obtaining an Abdominal X-ray to Assess for Constipation in Children

Abstract

Inspired by the ABIM Foundation's Choosing Wisely ® campaign, the "Things We Do for No Reason ™ " (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.

Things We Do for No Reason™: Routinely hospitalizing children with fecal impaction for inpatient cleanouts

“…Furthermore, initial testing rates vary nearly threefold and repeat testing rates vary more than 20‐fold across hospitals, suggesting that such testing may offer limited value while leading to patient harm (e.g., pain associated with phlebotomy) 13 . Similarly, 33% of children presenting to ED with constipation receive abdominal X‐rays, 9 despite no evidence of utility in diagnosing constipation and recommendations against routine imaging 3,14 . The use of nasogastric tubes to administer enteral laxatives in the hospital introduces additional risk from tube misplacement or radiation exposure to confirm placement.…”

Surgical Clinical Trials in Gynecology: Rare, Challenging but Desperately Needed

“…This pattern is ubiquitous across fields of medicine. For example, adults with stable angina continue to receive unneeded stents for stable angina [35], X-rays are commonly but inappropriately used to evaluate constipation in children [36], and 80% of antibiotics given before dental procedures are unnecessary [37]. Within OB-GYN, postmenopausal women continue to receive inappropriate hormone replacement therapy that could lead to elevated risks of cardiovascular disease and venous thromboembolisms [38], Pap smears are frequently performed unnecessarily without adding value in prevention of cervical cancer [39], and approximately 40% of antibiotics given perioperatively for gynecologic procedures are not indicated by professional guidelines [40].…”