Numerous assessments of the diagnostic utility and use of the direct rectal exam in trauma patients can be found in the current literature. ATLS advises doing a digital rectal exam on trauma patients after first evaluating their injuries. In populations with trauma, researchers sought to evaluate the diagnostic efficacy and validity of the digital rectal exam.
Studies were looked for in the databases of PubMed, Google Scholar, EMBASE, ProQuest, and CINAHL between the creation date of each database and August 6, 2022. Included were studies that examined the reliability of the digital rectal exam conducted on trauma patients of all ages in the emergency room or trauma bay. The results of the study and validity metrics were compared and summarized.
Nine studies, in total, satisfied the criteria for inclusion in the adult and pediatric trauma populations. In adult trauma populations, the digital rectal exam’s sensitivity for identifying spinal cord and urethral injuries varied from 0% to 50%, while its sensitivity for detecting gastrointestinal injuries ranged from 0% to 51%. The digital rectal examination regularly performed poorer in identifying injuries when compared to other clinical signs. The digital rectal exam has substantial false negative rates in the pediatric trauma groups, ranging from 66% to 100%, missing all urethral and gastrointestinal injuries and pelvic fractures.
The use of digital rectal examinations in trauma patients showed little to no validity and reliability in determining relevant injuries and has little bearing on how those injuries are managed. The use of digital rectal exams in particular situations and injury types should be made clearer by trauma societies by developing guidelines and algorithms.