Annals of Emergency Medicine
Volume 50, Issue 1 , Pages 25-33.e1, July 2007

Poor Test Characteristics for the Digital Rectal Examination in Trauma Patients

  • Gil Z. Shlamovitz, MD

      Affiliations

    • Department of Emergency Medicine, UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
    • Corresponding Author InformationAddress for correspondence: Gil Z. Shlamovitz, MD, UCLA Medical Center, 924 Westwood Boulevard Suite 300, Los Angeles, CA 90095; 310-794-0575, fax 310-794-0599
    • ,
  • William R. Mower, MD, PhD

      Affiliations

    • Department of Emergency Medicine, UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
    • ,
  • Jonathan Bergman, MD

      Affiliations

    • Department of Urology, UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
    • ,
  • Jonathan Crisp, MD, MS

      Affiliations

    • Department of Emergency Medicine, UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
    • ,
  • Heather K. DeVore, MD

      Affiliations

    • Department of Emergency Medicine, UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
    • ,
  • David Hardy, MD

      Affiliations

    • Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
    • ,
  • Martine Sargent, MD

      Affiliations

    • Department of Emergency Medicine, Highland General Hospital, Oakland, CA.
    • ,
  • Sunil D. Shroff, MD

      Affiliations

    • Department of Emergency Medicine, UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
    • ,
  • Eric Snyder, MD, MS

      Affiliations

    • Department of Emergency Medicine, UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
    • ,
  • Marshall T. Morgan, MD

      Affiliations

    • Department of Emergency Medicine, UCLA Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA

Received 27 October 2006; received in revised form 6 December 2006, 14 December 2006 and 21 December 2006; accepted 26 January 2007. published online 28 March 2007.

Study objective

Current advanced trauma life support guidelines recommend that a digital rectal examination be performed as part of the initial evaluation of all trauma patients. Our goal is to estimate the test characteristics of the digital rectal examination in trauma patients.

Methods

We conducted a retrospective medical record review study of consecutive trauma patients treated in our emergency department from January 2003 to February 2005 for whom the trauma team was activated and who had a documented digital rectal examination.

Results

One thousand four hundred one patients met our selection criteria and were included in the analysis. We estimated the composite sensitivity of the digital rectal examination (any abnormal finding) for detecting any of the index injuries to be 22.9% (95% confidence interval [CI] 16% to 30%) and the specificity to be 94.7% (95% CI 93% to 96%). The calculated sensitivity and specificity for the digital rectal examination were 37% (95% CI 23% to 50%) and 96% (95% CI 95% to 97%), respectively, for detection of spinal cord injury, 5.7% (95% CI 0% to 13%) and 98.9% (95% CI 98% to 99%) for detection of bowel injury, 33.3% (95% CI 0% to 87%) and 99.8% (95% CI 99% to 100%) for detection of rectal injury, 0% and 99.8% (95% CI 99% to 100%) for detection of pelvic fracture, and 20% (95% CI 0% to 55%) and 99% (95% CI 98% to 100%) for detection of urethral disruption.

Conclusion

The digital rectal examination has poor sensitivity for the diagnosis of spinal cord, bowel, rectal, bony pelvis, and urethral injuries. Our findings suggest that the digital rectal examination should not be used as a screening tool for detecting injuries in trauma patients.

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Supervising editors: Michael J. Schull, MD, MSc; Allan B. Wolfson, MDAuthor contributions: GZS conceived the study. GZS, MTM, and WRM designed the study. GZS supervised the conduct of the study and data collection and provided quality control. MTM and WRM contributed to the statistical analysis with advice, with GS doing the primary analysis. Data abstraction was done by GZS, JB, JC, HKD, DH, MS, SS, and ES. GZS drafted the article, with all authors contributing significantly to its revisions. GZS takes responsibility for the paper as a whole.Funding and support: The authors report this study did not receive any outside funding or support and there were no other conflicts of interest to declare. See the Manuscript Submission agreement form, published each month, for details of covered relationships.Publication dates: Available online March 27, 2007.Reprints not available from the authors.

PII: S0196-0644(07)00082-0

doi:10.1016/j.annemergmed.2007.01.022

Annals of Emergency Medicine
Volume 50, Issue 1 , Pages 25-33.e1, July 2007

Article Tools

* Image Usage & Resolution