Quality standard
Quality statement 1: Assessment
Quality statement 1: Assessment
Quality statement
Children and young people with constipation receive a full assessment before a diagnosis of idiopathic constipation is made.
Rationale
Children and young people with constipation can present to different types of healthcare professionals in primary, community and secondary care. Once constipation in children and young people has been recognised it is important to ensure that underlying causes of constipation and 'red flag' symptoms are excluded. A diagnosis of idiopathic constipation, in which the constipation cannot be explained by anatomical or physiological abnormalities, can only be made through a full assessment, including detailed history-taking and a physical examination by a healthcare professional.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that children and young people with constipation receive a full assessment before a diagnosis of idiopathic constipation is made.
Data source: Local data collection.
Process
Proportion of children and young people with constipation who receive a full assessment.
Numerator – the number in the denominator who receive a full assessment.
Denominator – the number of children and young people with constipation.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers ensure that staff are trained to perform a full assessment (including detailed history-taking and physical examination to exclude 'red flag' symptoms) for children and young people with constipation before making a diagnosis of idiopathic constipation.
Healthcare professionals perform a full assessment for children and young people with constipation (including detailed history-taking and physical examination to exclude 'red flag' symptoms) before making a diagnosis of idiopathic constipation.
Commissioners ensure that they commission services from providers whose staff perform a full assessment (including detailed history-taking and physical examination to exclude 'red flag' symptoms) for children and young people with constipation before making a diagnosis of idiopathic constipation.
Children and young people with constipation have a detailed assessment, which includes asking about their symptoms and other problems, and a physical examination. This will help to check that the constipation is not caused by anything serious.
Source guidance
Constipation in children and young people: diagnosis and management. NICE guideline CG99 (2010, updated 2017), recommendations 1.1.2 and 1.1.3
Definitions of terms used in this quality statement
Full assessment
A combination of history-taking and physical examination should be used to diagnose idiopathic constipation. Key components of assessment can be found in tables 1 to 3 in NICE's guideline on constipation in children and young people.
A positive diagnosis of idiopathic constipation can be established by excluding underlying causes. If a child or young person has any 'red flag' symptoms identified from history-taking or physical examination, do not treat them for constipation. Instead, refer them urgently to a healthcare professional with experience in the area of concern.
'Red flag' findings and diagnostic clues that indicate an underlying disorder or condition (not idiopathic constipation) are detailed in full in table 2 in NICE's guideline on constipation in children and young people for history-taking and in table 3 in NICE's guideline on constipation in children and young people for physical examination.
Assessment can be undertaken by healthcare professionals such as GPs, school nurses, health visitors, practice nurses, continence advisors and paediatricians. [NICE's guideline on constipation in children and young people and expert opinion]
Idiopathic constipation
Constipation that cannot (currently) be explained by any anatomical, physiological, radiological or histological abnormalities. [NICE's guideline on constipation in children and young people, Introduction]
Equality and diversity considerations
Certain groups of children and young people are more prone to idiopathic constipation than others, such as those with Down's syndrome or autism, and some children and young people with physical disabilities, such as cerebral palsy. There is also a higher prevalence of idiopathic constipation in children and young people in local authority care. These children and young people may have additional needs that should be considered when assessing them for idiopathic constipation.