Abdominal radiograph usage trends in the setting of constipation: a 10-year experience

Limited data are available to guide the use of abdominal radiographs in the setting of constipation, especially in adults. Anecdotally, there has been a recent increase in such examinations. We sought to determine ordering trends for abdominal radiographs ordered to assess constipation, as well as to better understand referring clinician and radiologist opinion on such examinations. We conducted a retrospective review of all abdominal radiographs performed between 2004 and 2014 at our institution with a primary indication of constipation. We also surveyed clinicians and radiologists regarding their opinions and practices involving such examinations. Constipation radiograph volume increased by approximately 56% over the 10-year period, while volume of all other abdominal radiographs decreased. Growth was greatest in adult females. Both radiologists and clinicians agree that constipation is a clinical diagnosis and are neutral as to whether radiographs help make the diagnosis. Clinicians somewhat agree that radiographs are helpful in determining management and find quantitation of stool burden within the radiology report helpful. Radiologists tend to find radiographs inaccurate at quantifying stool burden. Clinicians tend to agree that the increasing use of radiographs for constipation is appropriate while radiologists disagree. Education on these trends did not affect the intended future ordering practice of referring clinicians. Constipation abdominal radiograph volume has disproportionately increased, especially in adult women. Clinicians and radiologists agree that constipation is a clinical diagnosis. Otherwise, the groups tend to have differing opinions on the utility of such examinations. Clinicians indicated no intention to change their ordering practices. Further investigation is needed to better define the role of imaging for this indication, including how the radiologist may best interpret and report such examinations.