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Use of the rectal examination on children with acute abdominal pain
S J Scholer1, K Pituch, D P Orr
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA.
Insights
General pediatricians rarely perform rectal examinations on children with acute abdominal pain, with only 4.9% of cases involving this procedure. Factors like abdominal tenderness and constipation history increase the likelihood, while symptoms like cough decrease it.
Area of Science:
- Pediatric Medicine
- Gastroenterology
- Clinical Diagnostics
Background:
- Acute abdominal pain is a common pediatric complaint.
- The utility of rectal examination in diagnosing pediatric abdominal pain is debated.
- Understanding current practices and influencing factors is crucial for diagnostic accuracy.
Purpose of the Study:
- To determine the frequency of rectal examinations in children with acute abdominal pain.
- To identify clinical factors associated with performing a rectal examination.
Main Methods:
- Retrospective chart review of 1,140 children (2-12 years) presenting with acute abdominal pain.
- Data collection on demographics, symptoms, and rectal examination performance.
- Logistic regression analysis to identify associated factors.
Main Results:
- Rectal examination was performed in only 4.9% of cases.
- Abdominal tenderness, constipation history, and rectal bleeding increased examination likelihood.
- Cough, headache, and sore throat decreased examination likelihood.
- Clinically contributory findings were noted in 12 cases, including constipation and appendicitis.
Conclusions:
- General pediatricians infrequently perform rectal examinations for pediatric acute abdominal pain.
- Clinical presentation significantly influences the decision to perform a rectal examination.
- Further research may clarify the optimal role of rectal examination in this population.
Abstract:
The purpose of this study was to determine the frequency with which general pediatricians perform a rectal examination on children with a complaint of acute abdominal pain and to determine factors associated with performing a rectal examination. Children were eligible for the study if they were 2 to 12 years of age and presented to the clinic or emergency department of a municipal teaching hospital with a complaint of abdominal pain of less than or equal to three days' duration. Measured variables included demographic characteristics and presenting signs and symptoms. For each patient, a clinical reviewer (1) assigned a final diagnosis, (2) determined whether a rectal examination had been performed, and (3) assessed the clinical contribution of the rectal examination findings. For 1,140 children presenting for a nonscheduled visit with acute abdominal pain, a rectal examination was performed on 4.9% (56/1,140). Using multiple logistic regression, children were more likely to have a rectal examination performed if they had abdominal tenderness (odds ratio [OR] = 3.3 and 95% confidence interval [CI], 1.8 to 6.0), a history of constipation (OR = 6.0 and 95% CI, 2.3 to 15.3), or a history of rectal bleeding (OR = 9.1 and 95% CI, 2.9 to 29). Children were less likely to have had a rectal examination performed if they presented with associated symptoms of cough (OR = 0.32 and 95% CI, 0.14 to 0.74), headache (OR = 0.15 and 95% CI, 0.05 to 0.46), or sore throat (OR = 0.28 and 95% CI, 0.08 to 0.91). The final diagnoses of 12 children who had clinically contributory findings on rectal examination included: constipation (5), gastroenteritis (3), appendicitis (2), abdominal adhesions (1), and abdominal pain of unclear etiology (1). General pediatricians infrequently perform a rectal examination on children who present with a complaint of acute abdominal pain. Clinical factors affect the likelihood of whether a rectal examination is performed.