Clinical Characteristics of Children Needing Inpatient Treatment after Failed Outpatient Treatment for Fecal Impaction

PURPOSE: Treatment of chronic constipation and fecal impaction is usually outpatient and requires high or frequent doses of laxatives. However, there are children who fail outpatient treatments, sometimes repeatedly, and are ultimately hospitalized. We sought to compare the characteristics of the children who failed outpatient treatment and needed inpatient treatment vs those who achieved success with outpatient treatment, in an effort to identify attributes that might be associated with a higher likelihood towards hospitalization. METHODS: In this retrospective cohort study, we reviewed the medical records of all patients aged 0 to 21 years, with chronic functional constipation and fecal impaction seen in the pediatric gastroenterology clinic over a period of 2 years. RESULTS: Total of 188 patients met inclusion criteria. While 69.2% were successfully treated outpatient (referred to as the outpatient group), 30.9% failed outpatient treatment and were hospitalized (referred to as the inpatient group). The characteristics of the inpatient group including age at onset of 3.6±3.6 years (p=0.02); black ethnicity (odds ratio [OR] 4.31, 95% confidence interval [95% CI] 2.04–9.09); p<0.001); prematurity (OR 2.39, 95% CI 1.09–5.26; p=0.02]; developmental delay (OR 2.20, 95% CI 1.12–4.33; p=0.02); overflow incontinence (OR 2.26, 95% CI 1.12–4.53, p=0.02); picky eating habits (OR 2.02, 95% CI 1.00–4.08; p=0.04); number of ROME III criteria met: median 4, interquartile range 3–5 (p=0.04) and 13±13.7 constipation related prior encounters (p=0.001), were significantly different from the outpatient group. CONCLUSION: Identification of these characteristics may be helpful in anticipating challenges and potential barriers to effective outpatient treatment.