List Archives

Thu Jan 12 13:48:15 GMT 2006

Caesar,

Did the paper really say omiting the DRE saves time??  We are perhaps confusing statistical significance with clinical significance.  Why do you consider a rectal exam to be "cruel and unusual"??  Are we interested in saving time or taking care of patients?

Now "routine" DRE may be needed to be reassessed, but for patients with potential spinal cord injury or patients with penetrating abdominal trauma, the DRE does provide useful information.

As a tangent, many of our trauma patients do not have the most stellar record for having primary care physicians.  In the appropriate age groups, a full physical exam is, in fact, indicated as a general health care issue unrelated to the original trauma.

Regards,

Doug

Douglas Geehan, M.D.
Associate Professor
Department of Surgery
University of Missouri-Kansas City
geehand at umkc.edu

________________________________

From: trauma-list-bounces at trauma.org on behalf of Caesar Ursic
Sent: Wed 1/11/2006 10:11 AM
To: trauma-list at trauma.org
Subject: Trauma Rectal Exam: back to analog??

Yet another paper refuting the utility of the routine digital rectal
exam as part of the Trauma Secondary Survey:

Esposito, TJ, Ingraham, A, Luchette, FA, et al. Reasons to Omit
Digital Rectal Exam in Trauma Patients: No Fingers, No Rectum, No
Useful Additional Information. The Journal of Trauma: Injury,
Infection, and Critical Care: Volume 59(6) December 2005 pp
1314-1319).

"DRE rarely provides additional accurate or useful information that
changes management. Omission of DRE in virtually all trauma patients
appears permissible, safe, and advantageous. Elimination of routine
DRE from the secondary survey will presumably conserve time and
resources, minimize unpleasant encounters, and protect patients and
staff from the potential for further harm without any significant
negative impact on care and outcome." (excerpt from the paper)

Is it time to abandon this cruel and unusual practice once and for all?

CM Ursic, MD
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html

-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/ms-tnef
Size: 5621 bytes
Desc: not available
Url : http://list.mistral.net/pipermail/trauma-list/attachments/20060112/ea9e45b6/attachment.bin

List Archives

For your convenience, find the Trauma List Archive Below

Trauma Rectal Exam: back to analog??