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Performing a Digital Rectal Examination on Trauma Patients Does Not Increase the Likelihood of Detecting a Spinal Cord Injury

15 August 2009


Background: Current Advanced Trauma Life Support (ATLS) guidelines recommend a digital rectal examination (DRE) as part of the initial evaluation of all trauma patients. The finding of decreased or absent anal sphincter tone during the DRE is suggestive of spinal cord injury.

Hypothesis: The primary goal of this paper was to evaluate whether or not performing a digital rectal exam on trauma patients increases the likelihood of detecting a spinal cord injury, in the hopes that, when appropriate, the digital rectal examination may be deferred during the initial trauma evaluation.

Study Design: An exhaustive search of the available medical literature was performed, and relevant articles were analyzed to determine their validity and usefulness in answering the clinical question.

Methods: Ovid MEDLINE, CINAHL (EBSCOhost) and PubMed were searched using the keywords “digital rectal examination AND trauma OR wounds and injuries.” Bibliographic references found in the most relevant articles were also reviewed to identify additional applicable literature.

Results: Five articles were found that met all selection criteria, four of which were retrospective chart reviews, and one of which was a prospective trial.

Conclusion: In trauma patients, digital rectal examination does not increase the likelihood of detecting spinal cord injury. Advanced Trauma Life Support guidelines should be reviewed in consideration of this evidence.


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