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Related Experiment Videos

Digital rectal examination for trauma: does every patient need one?

J M Porter1, C M Ursic

  • 1Alameda County Medical Center, Oakland, California, USA.

The American Surgeon
|May 31, 2001
PubMed
Summary

The digital rectal examination rarely impacts trauma patient management. It is most useful for penetrating injuries, spinal cord concerns, or severe pelvic fractures, and the Hemoccult test is not recommended.

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Area of Science:

  • Emergency Medicine
  • Trauma Surgery
  • Clinical Assessment

Background:

  • The digital rectal examination (DRE) is a standard component of trauma assessment.
  • Evidence supporting its routine use in all seriously injured patients is lacking.

Purpose of the Study:

  • To evaluate the impact of the initial digital rectal examination on subsequent treatment and management decisions in trauma patients.
  • To identify specific patient populations where DRE may influence clinical care.

Main Methods:

  • Prospective observational study of 423 injured patients at a Level II trauma center over 6 months.
  • DRE performed during the secondary survey, noting findings like gross blood, Hemoccult results, prostate status, rectal vault integrity, and sphincter tone.
  • Correlated DRE findings with hemodynamic parameters, injury severity, and final patient disposition.

Main Results:

  • DRE influenced management in only 1.2% of cases (5 patients).
  • Gross blood on DRE prompted surgery in 3 patients with penetrating perineal/pelvic injuries, confirming rectal injuries.
  • Hemoccult positivity (5.2%) did not alter initial management; rectal sphincter tone assessment was rarely impactful, except in a malingering patient.

Conclusions:

  • Routine DRE in all seriously injured patients is unlikely to affect initial management.
  • DRE is most valuable for patients with penetrating injuries near the lower GI tract, suspected spinal cord damage, or severe pelvic fractures.
  • The Hemoccult test provides no useful information and should be removed from the trauma secondary survey.

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