Digital rectal examination and the primary care physicians: a lost art?
Shaista Safder1, Mary Rewalt, Yoram Elitsur
1Department of Pediatrics, Gastroenterology Division, Joan C. Edwards Medical Center, Marshall University, Huntington, WV 25701, USA.
Clinical Pediatrics
|August 8, 2006
Summary
Primary care physicians often skip digital rectal exams (DRE) in children with constipation. This omission leads to missed diagnoses and unnecessary specialist referrals, highlighting a need for better pediatric constipation care.
Area of Science:
- Pediatric Gastroenterology
- Clinical Practice Guidelines
Background:
- Digital rectal examination (DRE) is essential for diagnosing constipation in children.
- Primary care physicians (PCPs) may avoid performing DRE in pediatric constipation cases prior to referral.
Purpose of the Study:
- To determine the frequency of DRE performance by West Virginian PCPs for referred pediatric constipation patients.
- To assess the impact of DRE omission on diagnosis and treatment.
Main Methods:
- Retrospective chart review of referral letters.
- Parental self-report data collection.
- Analysis of DRE performance rates by PCPs.
Main Results:
- A significant majority (85%) of West Virginia PCPs do not perform DRE before referring children with constipation.
- This practice results in delayed or missed diagnoses and suboptimal treatment.
- Lack of DRE contributes to unnecessary specialist referrals.
Conclusions:
- The low rate of DRE performance by PCPs in pediatric constipation cases indicates a gap in standard care.
- Educational interventions for PCPs are necessary to improve diagnostic accuracy and patient outcomes.
- Implementing DRE can reduce unnecessary referrals and ensure timely, appropriate management of pediatric constipation.
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