An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children: Which is better?

Cynthia L. Leaphart, Melissa Danko, Laura Cassidy, Barbara Gaines, David Hackam

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)700-703
Number of pages4
JournalJournal of Pediatric Surgery
Volume41
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

Fingerprint

Proctoscopy
Tomography
Wounds and Injuries
Length of Stay
Injury Severity Score
Trauma Centers
Laparotomy
Physical Examination
Intensive Care Units
Demography

Keywords

  • CT scan
  • Diagnosis
  • Pediatric rectal injury
  • Pediatric surgery
  • Pediatric trauma
  • Proctoscopy
  • Rectal injury
  • Triple-contrast computed tomography

ASJC Scopus subject areas

  • Surgery

Cite this

An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children : Which is better? / Leaphart, Cynthia L.; Danko, Melissa; Cassidy, Laura; Gaines, Barbara; Hackam, David.

In: Journal of Pediatric Surgery, Vol. 41, No. 4, 04.2006, p. 700-703.

Research output: Contribution to journalArticle

Leaphart, Cynthia L. ; Danko, Melissa ; Cassidy, Laura ; Gaines, Barbara ; Hackam, David. / An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children : Which is better?. In: Journal of Pediatric Surgery. 2006 ; Vol. 41, No. 4. pp. 700-703.
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title = "An analysis of proctoscopy vs computed tomography scanning in the diagnosis of rectal injuries in children: Which is better?",
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.",
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N2 - 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.

AB - 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.

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