P0579 - Constipation: Comparing the Hospital Course Between Neurotypical and Neuroatypical Children

Introduction: Neuroatypical children, such as those who have autism spectrum disorder (ASD), sensory processing disorder, or developmental delay, commonly present to physicians with constipation. We compared various outcomes of neuroatypical children against neurotypical children admitted for constipation and hypothesized that neuroatypical patients would have longer lengths of stay with subsequent higher financial burden, and more resource usage than neurotypical patients.

Methods: This was a retrospective chart review conducted at an academic children’s hospital in Albany, New York from June 2013 to July 2019. All patients admitted to the hospital with a primary diagnosis of constipation or fecal impaction were eligible for inclusion. They were dichotomized into neuroatypical patients, defined as those with ASD, sensory processing disorder, or developmental delay, and those without these disorders (neurotypical). Multiple factors were assessed including restraints, both chemical and physical, as well as invasive procedures categorized as nasogastric tubes and manual disimpactions. Chi square testing was used to compare various outcomes between the two groups.

Results: 252 children were eligible for study inclusion. 20 were excluded for either misclassification of the primary diagnosis or missing data, leaving 87 patients who were neuroatypical and 145 patients who were neurotypical. Length of stay was 2.17 days in the neuroatypical group vs. 2.01 days in the neurotypical group (p = 0.3693). Cost of stay, however, was significantly higher in the neuroatypical group ($4,705.38 vs $3726.92, p<0.003). Readmissions, restraints, and invasive procedures were also statistically higher in the neuroatypical group as compared to the neurotypical group. Number of referrals, GI consults, previous bowel regimen, and route of administration of medications were not statistically significant.

Conclusion: Neuroatypical patients with constipation do not have higher lengths of stay as predicted, but do have higher costs. This is possibly related to increased frequency of invasive procedures as well as the need for behavioral modifications. Given this data, there is opportunity to increase standardizations of these patients as well as improve outpatient management with the goal being to decrease overall admissions for constipation. This study is limited to one academic center and would benefit from a large analysis including multiple hospitals.