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Abstract

Digital rectal examination (DRE) in children is crucial to differentiate between simple (habitual) and complicated constipation. Previous experience suggests that primary care physicians (PCPs) avoid DRE in children with constipation before referral. We evaluated the rate of DRE performance by West Virginian PCPs in patients referred to our gastroenterology clinic. Data were collected from the physicians’ referral letters and parental reports. We found that the vast majority (85%) of WV-PCPs do not perform DRE before referring their patients, resulting in missed diagnoses and treatment. We concluded that the lack of DRE in children with constipation may result in unnecessary referral to the specialist. To improve standard of care for children with constipation, an educational campaign for PCPs is clearly warranted.

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References

Borowitz SM , Cox DJ , Kovatchev B , et al. Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome. Pediatrics. 2005;115:873-877.

Baker SS , Liptak GS , Colletti RB , et al. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition.J Pediatr Gastroenterol Nutr. 1999;29(5):612-626.

Gold DM , Levine J , Weinstein TA , et al. Frequency of digital rectal examination in children with chronic constipation. Arch Pediatr Adolesc Med. 1999;153:377-379.

Greenberg LW. The rectal examination: a reminder of its importance. Clin Pediatr. 1974;13:1029-1030.

Freed GL , Nahra TA , Venus PJ , et al , and the research advisor committee of the American Board of Pediatrics . Changes in the proportion and volume of care provided to children by generalists and subspecialists. J Pediatr. 2005;146:14-19.

Scholer SJ , Pituch K , Orr DP , Dittus RS. Use of rectal examination on children with acute abdominal pain. Clin Pediatr. 1998;37:311-316.

Kirchner JT. Digital rectal examination in children with constipation. Am Fam Physician. 1999;60:1530-1531.

Leech SC , McHugh K , Sullivan PB. Evaluation of a method of assessing fecal loading on plain abdominal radiographs in children. Pediatr Radiol. 1999;29:255-258.

Rockney RM , McQuade WH , Days AL. The plain abdominal roentgenogram in the management of encopresis. Arch Pediatr Adolesc Med. 1995;149: 623-627.

10.

Pashankar DS , Loening-Baucke V , Bishop WP. Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children. Arch Pediatr Adolesc Med. 2003;157:661-664.

11.

Pashankar DS , Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr. 2001;139:428-432.

12.

Morales A , DiFilippo M , McKeand C , Elitsur Y. Treatment of constipation in children—a survey of primary care physicians in West Virginia. JPGN. 2005;41:498-498 (abstract).

Digital Rectal Examination and the Primary Care Physicians: A Lost Art?

Abstract

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