The benefits and clinical application of the digital rectal exam in trauma populations: Towards enhancing patient safety and quality outcomes

Abstract

Introduction: Current literature contains an extensive number of analyses on the diagnostic value and utilization of the direct rectal exam in trauma patients. Presently, ATLS recommends the application of the digital rectal exam in trauma patients following a primary assessment of traumatic injuries. We aim to assess the validity and diagnostic value of the digital rectal exam in trauma populations.

Methods: PubMed, Google Scholar, EMBASE, ProQuest, and CINAHL databases were searched for studies from the date of database conception to August 6th, 2022. Studies that assessed the validity of the digital rectal exam performed in the emergency department or trauma bay, in both adult and pediatric trauma patients were included. Study outcomes and measurements of validity were summarized and compared.

Results: A total of 9 studies met inclusion criteria for both adult and pediatric trauma populations. The sensitivity of the digital rectal exam in detecting both spinal cord and urethral injuries in adult trauma populations ranged from 0 to 50%, while the sensitivity in detecting gastrointestinal injuries ranged from 0% to 51%. When compared to other clinical indicators, the digital rectal exam was consistently worse at detecting injuries. Within the pediatric trauma populations, the digital rectal exam resulted in high false negative rates ranging from 66% to 100%, failing to detect all urethral and gastrointestinal injuries and pelvic fractures.

Conclusion: The use of digital rectal exams in trauma patients illustrates limited to no validity and reliability in assessing pertinent injuries and does not influence the management of injuries. Trauma societies should consider creating guidelines and algorithms to clarify the use of digital rectal exams in specific situations and injury types.

Keywords: Digital rectal exam; Outcomes; Reliability; Trauma; Validity.