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Rectal bleeding in the pediatric emergency department
1Division of Emergency Medicine, Children's Hospital, Boston, MA.
Insights
Rectal bleeding in children is usually not life-threatening. Emergency physicians can often make an accurate initial diagnosis of pediatric rectal bleeding that remains consistent with follow-up evaluations.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
Background:
- Rectal bleeding is a common pediatric complaint.
- Determining the etiology and severity is crucial for appropriate management.
Purpose of the Study:
- To describe presumptive diagnoses for pediatric rectal bleeding.
- To assess diagnostic changes with follow-up.
- To identify life-threatening causes of pediatric rectal bleeding.
Main Methods:
- Retrospective case series.
- Analysis of 109 pediatric emergency department visits for rectal bleeding.
- Follow-up data collected for 95 visits (87.1%) over a mean of 7.5 months.
Main Results:
- A presumptive diagnosis was established in 67% of initial visits and 77% at follow-up.
- Only 4.2% of cases presented with life-threatening conditions (intussusception, Meckel's diverticulum).
- Concordance between emergency department and follow-up diagnoses was 81%.
Conclusions:
- Pediatric rectal bleeding is typically not a life-threatening condition.
- Emergency physicians can establish reliable presumptive diagnoses for pediatric rectal bleeding.
- Diagnoses generally remain consistent from initial presentation through follow-up.
Study Objectives:
To describe the presumptive diagnoses in an unselected, ambulatory, pediatric population complaining of rectal bleeding; to determine how often those diagnoses changed with follow-up; and to determine how often the bleeding represented an acutely life-threatening condition.
Design:
Retrospective case series.
Setting:
Urban, tertiary care pediatric emergency department.
Participants:
One hundred four patients with 109 visits with a chief complaint of blood in the stool.
Interventions:
None.
Main Results:
Follow-up was available on 95 of 109 visits (87.1%), with a mean duration of 7.5 months. A specific presumptive etiology was established for 73 of 109 patients (67%) at the initial ED visit and for 74 of 95 patients (77%) at follow-up. The etiologies varied markedly by age. Four patients (4.2%; 95% confidence interval, 0.2% to 8.2%) presented with a life-threatening condition (requiring an RBC transfusion or operative intervention): intussusception (three patients) and Meckel's diverticulum (one patient). Concordance between the ED diagnosis and the follow-up diagnosis was 81%.
Conclusion:
A complaint of rectal bleeding is typically not life threatening in children. Emergency physicians normally are able to establish a presumptive diagnosis, which usually remains the same with follow-up.