Lack of evidence to support routine digital rectal examination in pediatric trauma patients.
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.
Shlamovitz
Gil Z
GZ
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
Mower
William R
WR
Bergman
Jonathan
J
Crisp
Jonathan
J
DeVore
Heather K
HK
Hardy
David
D
Sargent
Martine
M
Shroff
Sunil D
SD
Snyder
Eric
E
Morgan
Marshall T
MT
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*