Digital rectal examination for initial assessment of the multi-injured patient: Can we depend on it?
- Resource Type
- Authors
- Shahin Mohseni; Rebecka Ahl; Louis Riddez
- Source
- Annals of Medicine and Surgery
- Subject
- medicine.medical_specialty
urologic and male genital diseases
03 medical and health sciences
0302 clinical medicine
Medicine
030212 general & internal medicine
Original Research
ISS, Injury Severity Score
AIS, American Spinal Injury Association (ASIA) Impairment Scale
medicine.diagnostic_test
business.industry
General surgery
GIT, gastrointestinal tract
ICD-10, International Statistical Classification of Diseases & Related Health Problems
030208 emergency & critical care medicine
General Medicine
DRE - Digital rectal examination
Rectal examination
ATLS®, Advanced Trauma Life Support
Advanced trauma life support
Digital rectal examination
DRE, Digital Rectal Examination
General practice
Physical therapy
Injury Severity Score
Traumatic injury
Surgery
ISS - Injury severity score
business
- Language
- English
- ISSN
- 2049-0801
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. Materials and 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. Conclusion DRE in trauma settings has low sensitivity and does not change subsequent management. Excluding or postponing this examination should therefore be considered.
Highlights • There appears to be low correlation between examination and diagnosis. • Rectal examination shows poor test characteristics for detection of traumatic injury. • Digital rectal examination could be postponed following initial trauma assessment.