Digital Rectal Examination Reduces Hospital Admissions, Endoscopies, and Medical Therapy in Patients with Acute Gastrointestinal Bleeding
Autor: | Eugene Trowers, Mark Borgstrom, Manish P. Shrestha |
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Rok vydání: | 2017 |
Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class Clinical Decision-Making Colonoscopy Octreotide Proton-pump inhibitor 030204 cardiovascular system & hematology Endoscopy Gastrointestinal law.invention 03 medical and health sciences 0302 clinical medicine law medicine Humans 030212 general & internal medicine Aged Digital Rectal Examination Retrospective Studies medicine.diagnostic_test business.industry General surgery General Medicine Emergency department Rectal examination Odds ratio Middle Aged Intensive care unit Endoscopy Hospitalization Cross-Sectional Studies Female business Gastrointestinal Hemorrhage medicine.drug |
Zdroj: | The American journal of medicine. 130(7) |
ISSN: | 1555-7162 |
Popis: | Background Although digital rectal examination is an established part of physical examinations in patients with acute gastrointestinal bleeding, clinicians are reluctant to perform a rectal examination. We intended to assess whether rectal examination affects the clinical management decision in these patients. Methods We performed a single-center, retrospective, cross-sectional study using data from electronic health records of patients aged ≥18 years presenting to the emergency department with acute gastrointestinal bleeding. Hospital admissions, intensive care unit admissions, gastroenterology consultation, initiation of medical therapy (proton pump inhibitor or octreotide), and inpatient endoscopy (upper endoscopy or colonoscopy) were assessed as outcomes. Univariate and multivariate logistic regression analyses were performed. Results Of 1237 patients with acute gastrointestinal bleeding, 549 (44.4%) did not have a rectal examination. Patients who had a rectal examination were less likely to be admitted than patients who did not have a rectal examination (adjusted odds ratio [AOR], 0.49; 95% confidence interval [CI], 0.30-0.79; P = .004). Patients who had a rectal examination were less likely to be started on medical therapy (AOR, 0.64; 95% CI, 0.41-0.98; P = .04) and to have endoscopy (AOR, 0.64; 95% CI, 0.44-0.94; P = .02) than patients who did not have a rectal examination. Conclusions Rectal examination in patients with acute gastrointestinal bleeding can assist clinicians with clinical management decision and reduce admissions, endoscopies, and medical therapy in these patients. |
Databáze: | OpenAIRE |
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