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Use of the Rectal Examination on Children with Acute Abdominal Pain

Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute for Health Care, Indianapolis, IN; Division of General Pediatrics, Vanderbilt University School of Medicine, 5028 Medical Center East, Nashville, TN 37232-8555

Ken Pituch, MD

Don P. Orr, MD

Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN

Robert S. Dittus, MD, MPH

Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Bowen Research Center, Indianapolis, IN

The purpose of this study was to determine the frequency with which general pediatricians perform a rectal examination on children with a complaint of acute abdominal pain and to determine factors associated with performing a rectal examination. Children were eligible for the study if they were 2 to 12 years of age and presented to the clinic or emergency department of a municipal teaching hospital with a complaint of abdominal pain of less than or equal to three days' duration. Measured variables included demographic characteristics and presenting signs and symptoms. For each patient, a clinical reviewer (1) assigned a final diagnosis, (2) determined whether a rectal examination had been performed, and (3) assessed the clinical contribution of the rectal examination findings. For 1,140 children presenting for a nonscheduled visit with acute abdominal pain, a rectal examination was performed on 4.9% (56/1,140). Using multiple logistic regression, children were more likely to have a rectal examination performed if they had abdominal tenderness (odds ratio [OR]=3.3 and 95% confidence interval [CI], 1.8 to 6.0), a history of constipation (OR=6.0 and 95% CI, 2.3 to 15.3), or a history of rectal bleeding (OR=9.1 and 95% CI, 2.9 to 29). Children were less likely to have had a rectal examination performed if they presented with associated symptoms of cough (OR=0.32 and 95% CI, 0.14 to 0.74), headache (OR=0.15 and 95% CI, 0.05 to 0.46), or sore throat (OR=0.28 and 95% CI, 0.08 to 0.91). The final diagnoses of 12 children who had clinically contributory findings on rectal examination included: constipation (5), gastroenteritis (3), appendicitis (2), abdominal adhesions (1), and abdominal pain of unclear etiology (1). General pediatricians infrequently perform a rectal examination on children who present with a complaint of acute abdominal pain. Clinical factors affect the likelihood of whether a rectal examination is performed.

Clinical Pediatrics, Vol. 37, No. 5, 311-316 (1998)
DOI: 10.1177/000992289803700506


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