P4073 - Abdominal X-Rays Change Patient Management in the Outpatient Setting at a Tertiary Care Center

Dauris Rosario Lora, MD, Caroline Wang, MD, Zoë Post, MD, Salina Lee, MD
Rush University Medical Center, Chicago, IL

Introduction: Constipation is a gastrointestinal (GI) tract disorder that leads to decreased frequency, as well as increased difficulty to pass stool, that accounts for about 8 million annual patient visits in the US alone. An abdominal x-ray (AXR) is often part of the initial assessment of constipation in symptomatic patients. Although frequently ordered, they are not routinely recommended by national guidelines. We aimed to determine the rate of AXR ordered in our Gastroenterology Clinic and its association with timing of treatment, frequency of treatment adjustments, and chief complaints.

Methods: We retrospectively analyzed 317 electronic medical records of patients who established care in our clinic between December 2022 and January 2023. We excluded patients presenting for routine colorectal cancer screening, genetic cancer syndromes or previously diagnosed inflammatory bowel disease (IBD). Patient demographic data was recorded. Outcomes of interest included AXR ordered and completed, chief complaint, stool burden severity, and treatment start or modification date. Chi-square and Fisher exact test were used for statistical analysis.

Results: A total of 202 patients were included in the analysis. 68 AXR were ordered (33.7%). A total of 57 (83.8%) were completed. Most patients recommended an AXR on initial visit were female (71.2%) and white (38.4%), the mean age was 44.5 (SD= 19.8). Abdominal pain prompted the majority of AXR (39.7%). No association was found between chief complaints and AXR orders, nor between stool burden severity and initial chief complaint. 57.1% of patients in which an AXR was ordered on the initial visit, were subjected to change in treatment after their initial visit. There was a statistically significant association (p < 0.001) between timing of treatment and AXR ordered (table 1).

Discussion: Despite not being recommended by any guideline, our study shows that the use of AXR changes the treatment course in the majority of patients. Given the observed delay in treatment initiation, as well as a significant rate of uncompleted AXRs, a subgroup of patients may benefit from AXR prior to their initial visit. Our findings emphasize the importance of establishing specific criteria for AXR use.


Disclosures:


Dauris Rosario Lora, MD, Caroline Wang, MD, Zoë Post, MD, Salina Lee, MD. P4073 - Abdominal X-Rays Change Patient Management in the Outpatient Setting at a Tertiary Care Center, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.