title: Digital rectal examination for initial assessment of the multi-injured patient: Can we depend on it?
abstract: BACKGROUND
  Digital rectal examination (DRE) is part of the assessment of trauma patients as recommended by ATLS(®). The theory behind is to aid early diagnosis of potential lower intestinal, urethral and spinal cord injuries. Previous studies suggest that test characteristics of DRE are far from reliable. This study examines the correlation between DRE findings and diagnosis and whether DRE findings affect subsequent management.
  
  
  METHODS
  Patients with ICD-10 codes for spinal cord, urethral and lower intestinal injuries were identified from the trauma registry at an urban university hospital between 2007 and 2011. A retrospective review of electronic medical records was carried out to analyse DRE findings and subsequent management.
  
  
  RESULTS
  253 patients met the inclusion criteria with a mean age of 44 ± 20 years and mean ISS of 26 ± 16. 160 patients had detailed DRE documentation with abnormal findings in 48%. Sensitivity rate was 0.47. Correlational analysis between examination findings and diagnosis gave a kappa of 0.12. Subsequent management was not altered in any case due to DRE findings.
  
  
  CONCLUSIONS
  DRE in trauma settings has low sensitivity and does not change subsequent management. Excluding or postponing this examination should therefore be considered.
authors.affiliation: Department of Surgery, Division of Trauma and Acute Care Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden; Orebro University, 701 82 Orebro, Sweden.
authors.forename: Rebecka
authors.initials: R
authors.lastname: Ahl
authors.affiliation: Department of Surgery, Division of Trauma and Acute Care Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden.
authors.forename: Louis
authors.initials: L
authors.lastname: Riddez
authors.affiliation: Department of Surgery, Division of Trauma and Acute Care Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden; Department of Surgery, Division of Trauma and Acute Care Surgery, Orebro University Hospital, 701 85 Orebro, Sweden; Orebro University, 701 82 Orebro, Sweden.
authors.forename: Shahin
authors.initials: S
authors.lastname: Mohseni
keywords: AIS, American Spinal Injury Association (ASIA) Impairment Scale; ATLS®, Advanced Trauma Life Support; DRE, Digital Rectal Examination; Digital rectal examination; GIT, gastrointestinal tract; ICD-10, International Statistical Classification of Diseases & Related Health Problems; ISS, Injury Severity Score; Traumatic injury