title: The sensitivity and specificity of the digital rectal examination for detecting spinal cord injury in adult patients with blunt trauma.
abstract: OBJECTIVE
  The digital rectal examination (DRE) may assist physicians in detecting spinal cord injury in patients with blunt trauma. However, the test characteristics of the DRE for detecting spinal cord injury are unknown.
  
  
  METHODS
  We conducted a retrospective review of consecutive adult patients with blunt trauma over a 2-year period. The DRE result was compared with the presence or absence of spinal cord injury at discharge.
  
  
  RESULTS
  A total of 1032 adult patients with blunt trauma had a DRE. Of these, 54 (5.2%) had diagnoses consistent with spinal cord injury. Ninety-nine patients had decreased rectal tone, 27 of whom also had spinal cord injuries. The sensitivity, specificity, positive predictive value, and negative predictive values were 50%, 93%, 27%, and 97%, respectively.
  
  
  CONCLUSIONS
  The DRE is insensitive to spinal cord injury and has a poor positive predictive value. The high specificity must be balanced against the large number of false-positive results.
authors.affiliation: Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, CA 92354, USA. gguldner@ahs.llumc.edu
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Guldner
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Brzenski
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries; D051517:Digital Rectal Examination; D005189:False Positive Reactions; D006801:Humans; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000293:injuries; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*