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No Evidence Supporting the Routine Use of Digital Rectal Examinations in Trauma Patients

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Abstract

Digital rectal exams (DRE) are routinely used on trauma patients during the secondary survey as recommended by current Advanced Trauma Life Support (ATLS) protocols. However, recent literature has called the blanket use of the DRE on each trauma patient into question. The purpose of this study was to evaluate the efficacy of the DRE as a diagnostic tool in the setting of urethral, spinal cord, small bowel, colon, and rectal injuries and determine if it can be eliminated from routine use in the trauma setting. Trauma patients with small bowel, colon, rectal, urethral, and spinal cord injuries, age of 18 years or older, and a noted DRE were included. Exclusion criteria included an age less than 18, patients who received paralytics, a Glasgow Coma Scale (GCS) of 3, and a history of paraplegia or quadriplegia. One-hundred eleven patient records were retrospectively reviewed. Ninety-two male (82.9 %) and 19 (17.1 %) females with a GCS of 13.7 were evaluated. Sixty-two (55.9 %) injuries were penetrating with 49 (44.1) being blunt. The DRE missed 100 % of urethral, 91.7 % of spinal cord, 93.1 % of small bowel, 100 % of colon, and 66.7 % of rectal injuries. For injuries confirmed with radiologic modalities, the DRE missed 93.3 %. For injuries confirmed on exploratory laparotomy, the DRE missed 94.9 %. The DRE has poor sensitivity for the diagnosis of urethral, spinal cord, small bowel, and large bowel injury. The DRE was found to be the most sensitive in the setting of rectal injuries. The DRE offers no benefit or predictive value when compared to other imaging modalities.

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Conflict of Interest

The authors have no financial conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgery, NYU Lutheran Medical Center, 150 55th Street, Brooklyn, NY, 11220, USA

    Salvatore Docimo Jr.

  2. NYU Lutheran Medical Center, 150 55th Street, Brooklyn, NY, 11220, USA

    Laurence Diggs, Laura Crankshaw & Young Lee

  3. Department of Surgery, St. Barnabas Hospital, 4422 Third Avenue, Bronx, NY, 10457, USA

    Fausto Vinces

Authors
  1. Salvatore Docimo Jr.
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  2. Laurence Diggs
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  3. Laura Crankshaw
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  4. Young Lee
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  5. Fausto Vinces
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Correspondence to Salvatore Docimo Jr..

Additional information

Dr. Docimo provided substantial contributions to conception, design, analysis and interpretation of data, and manuscript preparation. Laurence Diggs, Laura Crankshaw, and Young Lee were involved in the acquisition of data and analysis. Dr. Vinces assisted with the revision and intellectual content of the manuscript. Dr. Docimo and Dr. Vinces gave the final approval for publication. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Docimo, S., Diggs, L., Crankshaw, L. et al. No Evidence Supporting the Routine Use of Digital Rectal Examinations in Trauma Patients. Indian J Surg 77, 265–269 (2015). https://doi.org/10.1007/s12262-015-1283-y

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  • DOI: https://doi.org/10.1007/s12262-015-1283-y

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