Medical College of Wisconsin
CTSIResearch InformaticsREDCap

An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children: which is better? J Pediatr Surg 2006 Apr;41(4):700-3; discussion 700-3

Date

03/29/2006

Pubmed ID

16567179

DOI

10.1016/j.jpedsurg.2005.12.012

Scopus ID

2-s2.0-33645294365 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

BACKGROUND: Current dogma suggests that the diagnosis of rectal injury can be made after physical examination and proctoscopy (PR). However, anecdotal evidence suggests that these modalities lack specificity when applied to children and that computed tomography (CT) scanning may be superior. A direct comparison between CT scanning and PR has not been performed. We therefore sought to compare CT with PR in the diagnosis of rectal injury by analyzing our large institutional experience.

METHODS: To assess institutional outcome, the charts of all children younger than 18 years admitted to our level I trauma center (1999-2004) were prospectively collected and retrospectively assessed. Demographics, diagnostic accuracy (PR vs CT), and outcome (length of stay, days in the intensive care unit [ICU], Injury Severity Score, and missed injury) were assessed.

RESULTS: There were 24 injuries (63% boys, 71% blunt, 100% survival), and diagnostic modality included the following: PR, 37.5%; CT, 37.5%; laparotomy alone, 8%. Length of stay (PR 5.7 +/- 6.2 vs CT 13.7 +/- 22.2, NS) were similar between groups. Of the missed rectal injuries, 66% of patients undergoing PR had missed injuries that were ultimately detected by CT whereas 33% of the patients undergoing CT scan had a missed injury.

CONCLUSION: CT is at least as accurate as PR in diagnosing pediatric rectal injury. Consideration of early scanning as opposed to PR may improve diagnosis and outcome in these patients.

Author List

Leaphart CL, Danko M, Cassidy L, Gaines B, Hackam DJ

Author

Laura Cassidy PhD Associate Dean, Director, Professor in the Institute for Health and Humanity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Female
Humans
Infant
Male
Proctoscopy
Rectum
Tomography, X-Ray Computed