David Mossad, MD1, Benita Wu, BS2, Sangeeta Agrawal, MD, FACG3
1Wright State University, Dayton, OH; 2Wright State University Boonshoft School of Medicine, Dayton, OH; 3Dayton VA Medical Center, Dayton, OH
Introduction: Digital rectal exam (DRE) is a critical component in evaluating gastrointestinal (GI) bleeds in the ambulatory setting. It is important in dictating medical management and decision making.1 Ideal patient outcomes, in such an acute setting, require selection of appropriate interventions and therapies. The purpose of this study was to evaluate the overall frequency in which this test is performed in patients presenting with GI bleed in the ambulatory setting.
Methods: The National Ambulatory Medical Care Survey (NAMCS) was searched using International Classification of Diseases - Ninth Revision (ICD-9) diagnosis codes for patients seen in the office for GI bleed for the years 2011-2015. Patients were separated into two groups: those who underwent DRE and those who did not. Data was analyzed based on ethnicity, gender, race, and age. Statistical comparisons were made using Statistical Package for the Social Sciences (SPSS) with chi-square and student T tests with a significance level of 0.05.
Results: A total of 265 ambulatory care patients with GI hemorrhage were identified. Only 38 patients (14%) underwent DRE. Between gender groups, there was no difference in DRE performed (13.3% of males vs 15.4% of females, p=0.727). Race had no significant impact on DRE rates when Asians, Whites and African Americans were compared (p=0.487). There was no difference in DRE rates in Hispanic versus Non- Hispanic ethnicity groups (p=0.087). Age was also found to be noncontributory to DRE performance (mean age of 54.3 for DRE vs 50.4 for no DRE, p= 0.349).
Discussion: With 14% of patients undergoing appropriate examination for GI hemorrhage, this study shows underutilization of DRE in the ambulatory setting. In this study, factors such as age, race, ethnicity and gender had no impact on DRE performance rates. GI bleeds can pose significant implications in morbidity and mortality and appropriate decision making is crucial for good patient outcomes. Evaluation of potential bleeds via DRE can impact clinical decision making and medical management in the form of admissions, endoscopic procedures and medical therapies. Proper physical examination in the setting of GI bleed should be emphasized in the ambulatory setting.
Citation: David Mossad, MD; Benita Wu, BS; Sangeeta Agrawal, MD, FACG. P1312 - UNDERUTILIZATION OF DIGITAL RECTAL EXAM IN THE EVALUATION OF PATIENTS WITH GASTROINTESTINAL BLEED IN THE AMBULATORY SETTING: ANALYSIS OF THE NATIONAL AMBULATORY MEDICAL CARE SURVEY. Program No. P1312. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.