Examinations,clinical Decisions And Outcomes:A Single-center Experience Of 4869 Children With Constipation In Outpatient

Objective: To analyze the clinical data of children with constipation in outpatient department,to investigate the risk factors related to the decision of treatment,clinical outcomes and pathological diagnosis for patients with constipation,and to explore the diagnostic value of classical triple examinations for Hirschsprung's disease(HSCR).Patients and Methods: From April 2006 to April 2016,children with constipation in outpatient department of our hospital were followed up for 2 to 10 years.Grouping and sub-grouping were carried out according to the treatment choices,clinical outcomes and pathological diagnosis.The influence factors were obtained by using SPSS19.0 for single factor and non-conditional multi-factor two-element logistic regression analysis.the sensitivity,specificity,positive prediction value,negative prediction value,Joden index and Kappa coefficient were calculated for triple examinations,in order to compare their values in diagnosing HSCR.Results: A total of 6115 children with constipation were recorded in outpatient department,in which 1246 children were excluded,and 4869 cases were enrolled in this study.1)Younger than 3 years old,24 h barium residue,AChE+~+++ were the common risk factors for failure of general treatment,necessity of upgrading to conservative or surgical treatment,outpatient choice for conservative treatment rather than general treatment(all,p<0.05);2)AChE++~+++ was the common risk factor for failure of conservative treatment,necessity of upgrading to surgical treatment,outpatient choice for surgical treatment rather than conservative treatment(all,p<0.05);while younger than 3 years old was the common protective factor(all,p<0.05);Male and absence of RAIR are risk factors for upgrading to surgical treatment,outpatient choice for surgical treatment rather than conservative treatment;3)male,younger than 3 years old,transitional zone,absence of RAIR,and AChE++~+++ were risk factors for diagnosis of HSCR(all,p<0.05).4)younger than 3years old was the common protective factor for postoperative recurrence of HSCR and HSCR allied disorders(HAD)(both,p<0.05);AChE++~+++ was the risk factor for postoperative recurrence of HAD(p<0.05).5)AChE ++~+++ in differentially diagnosing HSCR and HAD in children younger than 3 years old were of great significance,with highest sensitivity(95.5%),positive predictive value(94.1%),negative predictive value(78.6%),Joden Index(0.688)and Kappa coefficient(0.707),while barium enema had highest specificity(80% in patients ? 3 years old,and 78.3% in patients >3 years old respectively).Conclusions: The performance of triple examinations in outpatient department is of great significance in guiding the clinical dicision,predicting clinical outcomes and identifying HSCR and HAD.1)Male patients who have 24 h barium residue,absence of RAIR,AChE+~+++ may have more chance of failure when receiving general and conservative treatment,especially in children with AChE++~+++ who may have indications to undergo surgery directly;2)Patients with risk factors like male,younger than 3 years old,transitional zone,absence of RAIR,and AChE++~+++ is prone to diagnosis of HSCR.3)Patients with constipation younger than 3 years old have more chance of successful conservative treatment and have less incidence of recurrence of constipation,thus early diagnosis and intervention may be necessary to achieve better clinical outcomes.4)For children with AChE++~+++,it is necessary to consider the possibility of HSCR,but also to be cautious of HAD,which indicates that surgeons need to remove long enough colon to prevent recurrence.5)In outpatient department,classical triple examinations have different roles in diagnosing patients with HSCR or HAD,of which AChE staining is the most accurate and sensitive.