title: Lack of evidence to support routine digital rectal examination in pediatric trauma patients.
abstract: BACKGROUND
  Current advanced trauma life support guidelines recommend that a digital rectal examination (DRE) should be performed as part of the initial evaluation of all trauma patients. Our primary goal was to estimate the test characteristics of the DRE in pediatric patients for the following injuries: (1) spinal cord injuries, (2) bowel injuries, (3) rectal injuries, (4) pelvic fractures, and (5) urethral disruptions.
  
  
  METHODS
  We conducted a nonconcurrent, observational, chart review study of a consecutive series of pediatric trauma patients. We enrolled all patients younger than 18 years seen in our ED from January 2003 to February 2005, for whom the trauma team was activated and who had a documented DRE. For each patient, we reviewed all available clinical documents in a computerized medical record system to identify the DRE findings followed by review of radiological reports, operative reports, and discharge summaries to identify specific injuries.
  
  
  RESULTS
  Two hundred thirteen patients met our selection criteria and were included in the analysis. We identified 3 patients with spinal cord injury (1% prevalence), 13 patients with bowel injury (6%), 5 patients with rectal injury (2%), 12 patients with a pelvic fracture (6%), and 1 patient with urethral disruption (0.5%). The DRE failed to diagnose (false-negative rate) 66% of spinal cord injuries, 100% of bowel injuries, 100% of rectal wall injuries, 100% of pelvic fractures, and 100% of urethral disruption injuries.
  
  
  CONCLUSIONS
  The DRE has poor sensitivity for the diagnosis of spinal cord, bowel, rectal, bony pelvis, and urethral injuries. Our findings suggest that the DRE should not be routinely used in pediatric trauma patients.
authors.affiliation: Department of Emergency Medicine, University of California Los Angeles Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA. gilshla@yahoo.com
authors.forename: Gil Z
authors.initials: GZ
authors.lastname: Shlamovitz
authors.forename: William R
authors.initials: WR
authors.lastname: Mower
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bergman
authors.forename: Jonathan
authors.initials: J
authors.lastname: Crisp
authors.forename: Heather K
authors.initials: HK
authors.lastname: DeVore
authors.forename: David
authors.initials: D
authors.lastname: Hardy
authors.forename: Martine
authors.initials: M
authors.lastname: Sargent
authors.forename: Sunil D
authors.initials: SD
authors.lastname: Shroff
authors.forename: Eric
authors.initials: E
authors.lastname: Snyder
authors.forename: Marshall T
authors.initials: MT
authors.lastname: Morgan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D051517:Digital Rectal Examination; D004635:Emergency Medicine / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007422:Intestines / Q000293:injuries; D008297:Male; D010372:Pediatrics / Q000379:methods*; D010384:Pelvic Bones / Q000293:injuries; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000175:diagnosis; D014521:Urethra / Q000293:injuries; D014947:Wounds and Injuries / Q000175:diagnosis*