title: Utility of the digital rectal examination in the emergency department: a review.
abstract: BACKGROUND
  The digital rectal examination (DRE) has been reflexively performed to evaluate common chief complaints in the Emergency Department without knowing its true utility in diagnosis.
  
  
  OBJECTIVE
  Medical literature databases were searched for the most relevant articles pertaining to: the utility of the DRE in evaluating abdominal pain and acute appendicitis, the false-positive rate of fecal occult blood tests (FOBT) from stool obtained by DRE or spontaneous passage, and the correlation between DRE and anal manometry in determining anal tone.
  
  
  CONCLUSIONS
  Sixteen articles met our inclusion criteria; there were two for abdominal pain, five for appendicitis, six for anal tone, and three for fecal occult blood. The DRE was shown to add no additional diagnostic information and confounded the diagnosis in acute, undifferentiated abdominal pain. The sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio for the DRE were too low to reliably diagnose acute appendicitis in children and adults. No statistical differences in the number of colonic pathologies were found between stool collection methods in those with positive FOBT. The DRE correlation with anal manometry in determining resting and squeeze anal tone ranged from 0.405 to 0.82 and 0.52 to 0.97, respectively.
  
  
  CONCLUSIONS
  We found the DRE to have a limited role in the diagnosis of acute, undifferentiated abdominal pain and acute appendicitis. Stool obtained by DRE doesn't seem to increase the false-positive rate of FOBTs, and the DRE correlated moderately well with anal manometric measurements in determining anal sphincter tone.
authors.affiliation: Department of Emergency Medicine, Jesse Brown VA Medical Center, Chicago, Illinois 60612, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Kessler
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bauer
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D001003:Anal Canal / Q000503:physiopathology; D001064:Appendicitis / Q000175:diagnosis; D051517:Digital Rectal Examination; D004636:Emergency Service, Hospital; D005189:False Positive Reactions; D006801:Humans; D009780:Occult Blood