Rectal bleeding in the pediatric emergency department.
OBJECTIVE
To describe the presumptive diagnoses in an unselected, ambulatory, pediatric population complaining of rectal bleeding; to determine how often those diagnoses changed with follow-up; and to determine how often the bleeding represented an acutely life-threatening condition.


METHODS
Retrospective case series.


METHODS
Urban, tertiary care pediatric emergency department.


METHODS
One hundred four patients with 109 visits with a chief complaint of blood in the stool.


METHODS
None.


RESULTS
Follow-up was available on 95 of 109 visits (87.1%), with a mean duration of 7.5 months. A specific presumptive etiology was established for 73 of 109 patients (67%) at the initial ED visit and for 74 of 95 patients (77%) at follow-up. The etiologies varied markedly by age. Four patients (4.2%; 95% confidence interval, 0.2% to 8.2%) presented with a life-threatening condition (requiring an RBC transfusion or operative intervention): intussusception (three patients) and Meckel's diverticulum (one patient). Concordance between the ED diagnosis and the follow-up diagnosis was 81%.


CONCLUSIONS
A complaint of rectal bleeding is typically not life threatening in children. Emergency physicians normally are able to establish a presumptive diagnosis, which usually remains the same with follow-up.
Teach
S J
SJ
Division of Emergency Medicine, Children's Hospital, Boston, MA.
Fleisher
G R
GR
D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D012007:Rectum; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies