|
Sign In to gain access to subscriptions and/or personal tools.
|
Digital Rectal Examination and the Primary Care Physicians: A Lost Art?
Shaista Safder, MD
Department of Pediatrics, Gastroenterology Division, Joan C. Edwards Medical Center, Marshall University, Huntington, WV.
Mary Rewalt, BA
Department of Pediatrics, Gastroenterology Division, Joan C. Edwards Medical Center, Marshall University, Huntington, WV.
Yoram Elitsur, MD
Department of Pediatrics, Gastroenterology Division, Joan C. Edwards Medical Center, Marshall University, Huntington, WV.
Digital rectal examination (DRE) in children is crucial to differentiate between simple (habitual) and complicated constipation. Previous experience suggests that primary care physicians (PCPs) avoid DRE in children with constipation before referral. We evaluated the rate of DRE performance by West Virginian PCPs in patients referred to our gastroenterology clinic. Data were collected from the physicians’ referral letters and parental reports. We found that the vast majority (85%) of WV-PCPs do not perform DRE before referring their patients, resulting in missed diagnoses and treatment. We concluded that the lack of DRE in children with constipation may result in unnecessary referral to the specialist. To improve standard of care for children with constipation, an educational campaign for PCPs is clearly warranted.
References
- Borowitz SM, Cox DJ, Kovatchev B, et al. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics. 2005;115:873-877.[Abstract/Free Full Text]
- Baker SS, Liptak GS, Colletti RB, et al. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition.J Pediatr Gastroenterol Nutr. 1999;29(5):612-626.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Gold DM, Levine J, Weinstein TA, et al. Frequency of digital rectal examination in children with chronic constipation. Arch Pediatr Adolesc Med. 1999;153:377-379.[Abstract/Free Full Text]
- Greenberg LW. The rectal examination: a reminder of its importance. Clin Pediatr. 1974;13:1029-1030.[Free Full Text]
- Freed GL, Nahra TA, Venus PJ, et al, and the research advisor committee of the American Board of Pediatrics. Changes in the proportion and volume of care provided to children by generalists and subspecialists. J Pediatr. 2005;146:14-19.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Scholer SJ, Pituch K, Orr DP, Dittus RS. Use of rectal examination on children with acute abdominal pain. Clin Pediatr. 1998;37:311-316.[Abstract/Free Full Text]
- Kirchner JT. Digital rectal examination in children with constipation. Am Fam Physician. 1999;60:1530-1531.
- Leech SC, McHugh K, Sullivan PB. Evaluation of a method of assessing fecal loading on plain abdominal radiographs in children. Pediatr Radiol. 1999;29:255-258.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Rockney RM, McQuade WH, Days AL. The plain abdominal roentgenogram in the management of encopresis. Arch Pediatr Adolesc Med. 1995;149: 623-627.[Abstract/Free Full Text]
- Pashankar DS, Loening-Baucke V, Bishop WP. Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children. Arch Pediatr Adolesc Med. 2003;157:661-664.[Abstract/Free Full Text]
- Pashankar DS, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr. 2001;139:428-432.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Morales A, DiFilippo M, McKeand C, Elitsur Y. Treatment of constipation in children—a survey of primary care physicians in West Virginia. JPGN. 2005;41:498-498 (abstract).
Clinical Pediatrics, Vol. 45, No. 5,
411-414 (2006)
DOI: 10.1177/0009922806289615
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter What's this?
|
|
