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 ,Revised 21 December 2006 ,Accepted 26 January 2007.

References 

  1. McCaig LF, Nawar EN. National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. Adv Data. 2006;372:1–29
  2. American College of Surgeons Committee on Trauma. In: Initial Assessment and Management (Advanced Trauma Life Support for Doctors). 7th ed.. Chicago, IL: American College of Surgeons; 2004;p. 18–19
  3. Cornwell EE. Initial approach to trauma. In:  Tintinalli JE editors. Emergency Medicine: A Comprehensive Study Guide. 6th ed.. New York, NY: McGraw-Hill; 2004;p. 1540–1541
  4. Parks SN. Initial assessment. In:  Moore EE,  Feliciano DV,  Mattox KL editor. Trauma. 5th ed.. New York, NY: McGraw-Hill; 2004;p. 141–156
  5. Gilbert EH, Lowenstein SR, Koziol-McLain J, et al. Chart reviews in emergency medicine research: where are the methods?. Ann Emerg Med. 1996;27:305–308
  6. Worster A, Bledsoe RD, Cleve P, et al. Reassessing the methods of medical record review studies in emergency medicine research. Ann Emerg Med. 2005;45:448–451
  7. Worster A, Haines T. Advanced statistics: understanding medical record review (MRR) studies. Acad Emerg Med. 2004;11:187–192
  8. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174
  9. Guldner GT, Brzenski AB. The sensitivity and specificity of the digital rectal examination for detecting spinal cord injury in adult patients with blunt trauma. Am J Emerg Med. 2006;24:113–117
  10. Porter JM, Ursic CM. Digital rectal examination for trauma: does every patient need one?. Am Surg. 2001;67:438–441
  11. Esposito TJ, Ingraham A, Luchette FA, et al. Reasons to omit digital rectal exam in trauma patients: no fingers, no rectum, no useful additional information. J Trauma. 2005;59:1314–1319
  12. Levine H, Simon RJ, Smith TR, et al. Guaiac testing in the diagnosis of rectal trauma: what is its value?. J Trauma. 1992;32:210–212
  13. Leaphart CL, Danko M, Cassidy L, et al. An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children: which is better?. J Pediatr Surg. 2006;41:700–703
  14. Ziran BH, Chamberlin E, Shuler FD, et al. Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures. J Trauma. 2005;58:533–537
  15. Koraitim MM. Pelvic fracture urethral injuries: the unresolved controversy. J Urol. 1999;161:1433–1441
  16. Brandes S. Initial management of anterior and posterior urethral injuries. [review] Urol Clin North Am. 2006;33:87–95vii
  17. Guldner G, Babbitt J, Boulton M, et al. Deferral of the rectal examination in blunt trauma patients: a clinical decision rule. Acad Emerg Med. 2004;11:635–641
  18. Malangoni MA, Botner BK, Amin EA, et al. Blunt urethral injury: results of initial management. Am Surg. 1988;54:181–184

 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

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