title: Digital Rectal Examination Reduces Hospital Admissions, Endoscopies, and Medical Therapy in Patients with Acute Gastrointestinal Bleeding.
abstract: Although digital rectal examination is an established part of physical examinations in patients with acute gastrointestinal bleeding, clinicians are reluctant to perform a rectal examination. We intended to assess whether rectal examination affects the clinical management decision in these patients.
  
  
  
  We performed a single-center, retrospective, cross-sectional study using data from electronic health records of patients aged ≥18 years presenting to the emergency department with acute gastrointestinal bleeding. Hospital admissions, intensive care unit admissions, gastroenterology consultation, initiation of medical therapy (proton pump inhibitor or octreotide), and inpatient endoscopy (upper endoscopy or colonoscopy) were assessed as outcomes. Univariate and multivariate logistic regression analyses were performed.
  
  
  
  Of 1237 patients with acute gastrointestinal bleeding, 549 (44.4%) did not have a rectal examination. Patients who had a rectal examination were less likely to be admitted than patients who did not have a rectal examination (adjusted odds ratio [AOR], 0.49; 95% confidence interval [CI], 0.30-0.79; P = .004). Patients who had a rectal examination were less likely to be started on medical therapy (AOR, 0.64; 95% CI, 0.41-0.98; P = .04) and to have endoscopy (AOR, 0.64; 95% CI, 0.44-0.94; P = .02) than patients who did not have a rectal examination.
  
  
  
  Rectal examination in patients with acute gastrointestinal bleeding can assist clinicians with clinical management decision and reduce admissions, endoscopies, and medical therapy in these patients.
authors.affiliation: Department of Medicine, University of Arizona College of Medicine, Tucson.
authors.forename: Manish P
authors.initials: MP
authors.lastname: Shrestha
authors.affiliation: Research Computing Group of University Information Technology Services, University of Arizona, Tucson.
authors.forename: Mark
authors.initials: M
authors.lastname: Borgstrom
authors.affiliation: Division of Gastroenterology, University of Arizona College of Medicine, Tucson. Electronic address: etrowers@deptofmed.arizona.edu.
authors.forename: Eugene
authors.initials: E
authors.lastname: Trowers
mesh_terms: D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D051517:Digital Rectal Examination; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Acute gastrointestinal bleeding; Admissions; Digital rectal examination; Endoscopy