Prevalence of Serious Diagnoses and Disposition among Older Adults Presenting with a Chief Complaint of Constipation, a Retrospective Repeated Cross-sectional Study

A chief complaint of “constipation” in the emergency department (ED) is generally considered low-risk, and potentially suitable for lower acuity care. However, it may also indicate abdominal pain perceived as lower severity by triage staff, despite being relatively high-risk. We hypothesized that ED visits for constipation in older adults would more frequently result in the diagnosis of serious, treatable conditions compared to younger adults. We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) over an 8-year period (2013-2020). Older adults with constipation were more likely to be non-Hispanic White. Among adults with constipation, 25.6% (95% CI: 22.8-28.4) received intravenous fluids, 15.5% (95% CI: 11.9-19.1) had an emergency general surgical diagnosis, and 9.7% were admitted to the hospital. Older adults had less ultrasound use but more operative management compared to younger adults. In older adults, 15.2% of ED visits carried an emergency general surgical diagnosis, compared to 15.7% in younger adults. Leading diagnoses included intestinal impaction, gastro-esophageal reflux disease without esophagitis, ileus, diverticular disease of the large intestine without perforation or abscess, and anal dysplasia. Approximately one in ten patients presenting to the ED with constipation required significant medical intervention, a rate similar to atraumatic low back pain. While the admission rate for constipation-related visits is lower than for geriatric abdominal or chest pain, it remains common. Clinicians should maintain a high index of suspicion and order appropriate tests based on clinical evaluation, particularly in older adults. Further research may lead to a “red flag” approach to better identify serious conditions without excessive testing.