RECTAL BLEEDING IN THE PEDIATRIC EMERGENCY DEPARTMENT

Study objectives: To describe the presumptive diagnoses in an unselect ed, ambulatory, pediatric population complaining of rectal bleeding; t o determine how often those diagnoses changed with follow-up; and to d etermine how often the bleeding represented an acutely life-threatenin g condition. Design: Retrospective case series. Setting: Urban, tertia ry care pediatric emergency department. Participants: One hundred four patients with 109 visits with a chief complaint of blood in the stool . Interventions: None. Main results: Follow-up was available on 95 of 109 visits (87.1%), with a mean duration of 7.5 months. A specific pre sumptive etiology was established for 73 of 109 patients (67%) at the initial ED visit and for 74 of 95 patients (77%) at follow-up. The eti ologies varied markedly by age. Four patients (4.2%; 95% confidence in terval, 0.2% to 8.2%) presented with a life-threatening condition (req uiring an RBC transfusion or operative intervention): intussusception (three patients) and Meckel's diverticulum (one patient). Concordance between the ED diagnosis and the follow-up diagnosis was 81%. Conclusi on: A complaint of rectal bleeding is typically not life threatening i n children. Emergency physicians normally are able to establish a pres umptive diagnosis, which usually remains the same with follow-up.