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The digital rectal examination in pediatric trauma: a pilot study.
George Kristinsson1, Stephen P Wall, Ellen F Crain
1Department of Pediatrics (Division of Emergency Medicine), Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
The Journal of Emergency Medicine
|January 24, 2007
Summary
This pilot study found that routine digital rectal examination (DRE) in pediatric trauma patients did not improve the identification of serious injuries. The DRE
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Surgical Assessment
Background:
- The digital rectal examination (DRE) is a component of the secondary survey in trauma patients.
- Its utility in pediatric trauma, particularly for identifying spinal, pelvic, or lower intestinal injuries, remains debated.
- This study aimed to evaluate the diagnostic value of DRE in this specific population.
Purpose of the Study:
- To assess the effectiveness of routine digital rectal examination (DRE) in identifying significant injuries in pediatric trauma patients.
- To determine if DRE improves the sensitivity and negative predictive value of the physical examination in this cohort.
- To evaluate the association between DRE findings and specific DRE-identifiable injuries.
Main Methods:
- A prospective pilot study enrolled 135 pediatric trauma patients (0-18 years) with spinal or trunk trauma at an urban Level I trauma center.
- Abnormal DRE was defined by specific criteria including blood, tone, integrity, and prostate position.
- DRE-identifiable injuries included spinal, pelvic, rectal, lower intestinal, and urethral injuries.
Main Results:
- Eight out of 135 patients had DRE-identifiable injuries.
- The sensitivity and negative predictive value of the physical examination were equivalent with or without the DRE.
- Routine DRE did not enhance the detection of serious injuries during the secondary survey.
Conclusions:
- Routine digital rectal examination may not be a necessary component of the secondary survey for pediatric trauma patients.
- The findings suggest that DRE does not significantly improve the identification of critical injuries in this population.
- Further research may be warranted to refine guidelines for DRE use in pediatric trauma assessment.
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