W1904 Stool Retention Patterns Assessed by Abdominal Radiography in Hospitalized Older Adults With Constipation

Abstract

Context: Information is limited in the stool retention (SR) and distribution patterns of constipated older adults. Objective: By using a radiographic scoring system for assessing the severity of SR in hospitalized constipated elderly, we investigate SR distribution patterns between two groups (highvs. low-scored) and to identify factors associated with high and low SR scores. Method: Adults aged ≥65 years admitted to a community hospital between 2005 and 2008 who were discharged with primary or secondary diagnosis of constipation without bowel obstruction and also had abdominal radiographs during the stay (N=131). Poor quality films (N=9) were excluded. Abdominal radiographs were scored by four readers. A score 0-5 (5 being the most severe) for each quadrant of radiographs (total score: 0-20) was used to estimate the severity of SR. Each quadrant represents the approximate location of ascending (Q1), transverse (Q2), descending (Q3), and recto-sigmoid colon area (Q4). Those with scores ≥ 13 were in the high-scored group (N=71); ≤12 in the low-scored group (N=39). Results: The range of average total SR scores was 7 to 18.9; mean score ±SD, 13.4±2.5. The high-scored group was younger than the low-scored group (mean±SD: 81.4±8.2 vs. 86.8±7.3 years, p<.001). The corresponding average score of SR was 3.9±1.0, 3.1±.9, 3.7±.7, and 4.4±.8 in the high-scored group, and 2.2±1.0, 2.0±.7, 2.8±.9, and 3.5±1.2 in the low-scored group, for each quadrant Q1-Q4 respectively. The high-scored group had significantly higher scores in all four quadrants compared to the low-scored group, p<.001, with the greatest difference in the ascending colon area (absolute difference 1.7). Factors positively associated with high scores were the use of antimuscarinics [8(11%) vs. 0(0%), p=.049] and statins (OR=4.71; 95% CI:1.30-17.03). Antibiotic use was associated with low scores (OR=.32; 95% CI: 0.11-.92). After adjusting for age, sex, and the use of oral laxatives, the association between SR scored status and the use of statin and antibiotics remained significant. Female sex became significantly associated with high-scored SR (adjusted OR=3.14; 95% CI:1.05-9.42). There was no difference in residency, discharge diagnoses, medical history, levels of potassium, calcium, and albumin on admission, and length of hospital stay between the two groups. Conclusion: Our study suggested that the greatest difference in SR severity between the highand low-scored groups was in the ascending colon area. Our study also identified that female sex and the use of statins was associated with high SR scores; while advancing age and the use of antibiotic was associated with low SR scores.