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Likelihood Ratio (LR) in Emergency Medicine


Rectal Examination and Appendicitis

A 25 y/o man comes to the ED because of abdominal pain started 2 hours before, fever and vomit.
He has not history of disease, no history of surgery, no history of other ED admission for abdominal pain.
Clinical examination shows rigidity and diffused painfull abdomen.

You perform digital rectal examination were you evidence no pain in the Douglas space and normal stool, can you exclude appendicitis?.


Digital rectal examination (DRE) is not necessary in patients with suspected acute appendicitis, it provides no additional information that is not available on the abdominal examination.
It is not useful in comparison with the discomfort and privacy problems that often accompany its use, it can be very unpleasant for the patient. 
There is also poor evidence regarding the clinical utility of the DRE in the diagnosis of undifferentiated abdominal pain.


R. E. B. Andersson
Meta-analysis of the clinical and laboratory diagnosis of appendicitis
British Journal of Surgery 2004; 91: 28–37

J Quaas , M Lanigan, D Newman, J McOsker, R Babayev, C Mason
Utility of the digital rectal examination in the evaluation of undifferentiated abdominal pain
American Journal of Emergency Medicine (2009) 27, 1125–1129

S A Colucciello, T W Lukens, D L Morgan 
Assessing Abdominal Pain In Adults: A Rational, Cost-Effective, And Evidence-Based Strategy
Emergency Medicine Practice, Premier Issue Volume1,Number1, 1999

N Manimaran, RB Galland
Significance of routine digital rectal examination in adults presenting with abdominal pain
Ann R Coll Surg Engl 2004; 86: 292–295

Ilenia Spallino


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