Importance
Constipation is a common cause of pediatric abdominal pain and emergency department (ED) presentation. Despite the high prevalence, there is a dearth of clinical information and wide practice variation in childhood constipation management in the ED.
Objective
To assess the efficacy and safety of soap suds enema (SSE) in the treatment of fecal impaction in children with abdominal pain within the pediatric emergency department (ED) setting. The primary outcome was stool output following SSE. Secondary outcomes were adverse events, admissions, and return visits within 72 hours.
Methods
This is a retrospective cross-sectional study performed in the ED at a quaternary care children’s hospital of patients seen over a 12-month period who received a SSE for fecal impaction.
Results
Five hundred twelve patients (53% female, median age 7.8 years, range: 8 months-23 years) received SSE therapy over a 1-year period. Successful therapy (bowel movement) following SSE occurred in 419 (82%). Adverse events included abdominal pain in 24 (5%) and nausea/vomiting in 18 (4%). No SSE-related serious adverse events were identified. Following SSE, 405 (79%) were subsequently discharged, of which 15 (3.7%) returned to the ED for re-evaluation within 72 hours.
Conclusions and Relevance
SSE is an efficacious and safe therapeutic option for the acute treatment of childhood fecal impaction in the ED setting.
Background: A modified non-technical skills scale for trauma (T-NOTECHS) for assessment of leadership skills in trauma resuscitations has been described in surgical literature. The utility of this tool with Pediatric Emergency Medicine (PEM) providers has not been explored. The objectives of this study were to assess the utility of the T-NOTECHS scoring tool in the pediatric setting and identify barriers to leading a thorough and efficient trauma evaluation.
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