The fall of the digital rectal exam

For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications. As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable for patients already traumatized and its yield is so minimal, he advocates doing it in only patients with spinal cord injury, pelvic fracture, and penetrating abdominal trauma. For a more extensive discussion of the topic, see Life in the Fastlane, an emergency medicine blog. A systematic review and meta-analysis of the role of DRE in prostate cancer screening done by primary care physicians was just published in Annals of Family Medicine. Seven studies including 9241 patients who had both DRE and biopsy comprised the study. The authors found the sensitivity of DRE was only 0.51 and the specificity was 0.59. The positive predictive value was 0.41, and the negative predictive value was 0.64. In other words, it was similar to flipping a coin. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Emergency Medicine Oncology/Hematology Source Type: blogs