USE OF THE RECTAL EXAMINATION ON CHILDREN WITH ACUTE ABDOMINAL-PAIN

The purpose of this study was to determine the frequency with which ge neral pediatricians perform a rectal examination on children with a co mplaint of acute abdominal pain and to determine factors associated wi th performing a rectal examination. Children were eligible for the stu dy if they were 2 to 12 years of age and presented to the clinic or em ergency department of a municipal teaching hospital with a complaint o f abdominal pain of less than or equal to three days' duration. Measur ed variables included demographic characteristics and presenting signs and symptoms. For each patient, a clinical reviewer (1) assigned a fi nal diagnosis, (2) determined whether-a rectal examination had been pe rformed, and (3) assessed the clinical contribution of the rectal exam ination findings. For 1,140 children presenting fbr a nonscheduled vis it 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 te nderness (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 I-ectal examination performed if they p resented with associated symptoms of rough (OR-0.32 and 95% CI, 0.14 t o 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 include d: constipation (5), gastroenteritis (3), appendicitis (2), abdominal adhesions (1), and abdominal pain of unclear etiology (1). General ped iatricians infrequently perform a rectal examination on children who p resent with a complaint of acute abdominal pain. Clinical factors affe ct the likelihood of whether a rectal examination is performed.