S J Teach1, G R Fleisher. 1. Division of Emergency Medicine, Children's Hospital, Boston, MA.
Abstract
STUDY OBJECTIVES: To describe the presumptive diagnoses in an unselected, ambulatory, pediatric population complaining of rectal bleeding; to determine how often those diagnoses changed with follow-up; and to determine how often the bleeding represented an acutely life-threatening condition. DESIGN: Retrospective case series. SETTING: Urban, tertiary care pediatric emergency department. PARTICIPANTS: One hundred four patients with 109 visits with a chief complaint of blood in the stool. INTERVENTIONS: None. MAIN RESULTS: Follow-up was available on 95 of 109 visits (87.1%), with a mean duration of 7.5 months. A specific presumptive etiology was established for 73 of 109 patients (67%) at the initial ED visit and for 74 of 95 patients (77%) at follow-up. The etiologies varied markedly by age. Four patients (4.2%; 95% confidence interval, 0.2% to 8.2%) presented with a life-threatening condition (requiring an RBC transfusion or operative intervention): intussusception (three patients) and Meckel's diverticulum (one patient). Concordance between the ED diagnosis and the follow-up diagnosis was 81%. CONCLUSION: A complaint of rectal bleeding is typically not life threatening in children. Emergency physicians normally are able to establish a presumptive diagnosis, which usually remains the same with follow-up.
STUDY OBJECTIVES: To describe the presumptive diagnoses in an unselected, ambulatory, pediatric population complaining of rectal bleeding; to determine how often those diagnoses changed with follow-up; and to determine how often the bleeding represented an acutely life-threatening condition. DESIGN: Retrospective case series. SETTING: Urban, tertiary care pediatric emergency department. PARTICIPANTS: One hundred four patients with 109 visits with a chief complaint of blood in the stool. INTERVENTIONS: None. MAIN RESULTS: Follow-up was available on 95 of 109 visits (87.1%), with a mean duration of 7.5 months. A specific presumptive etiology was established for 73 of 109 patients (67%) at the initial ED visit and for 74 of 95 patients (77%) at follow-up. The etiologies varied markedly by age. Four patients (4.2%; 95% confidence interval, 0.2% to 8.2%) presented with a life-threatening condition (requiring an RBC transfusion or operative intervention): intussusception (three patients) and Meckel's diverticulum (one patient). Concordance between the ED diagnosis and the follow-up diagnosis was 81%. CONCLUSION: A complaint of rectal bleeding is typically not life threatening in children. Emergency physicians normally are able to establish a presumptive diagnosis, which usually remains the same with follow-up.
Authors: Laura Stampfer; Andrea Deutschmann; Elisabeth Dür; Franz G Eitelberger; Theresia Fürpass; Gregor Gorkiewicz; Peter Heinz-Erian; Ingrid Heller; Kathrin Herzog; Barbara Hopfer; Reinhold Kerbl; Evelyn Klug; Robert Krause; Eva Leitner; Christoph Mache; Thomas Müller; Jasmin Pansy; Mirjam Pocivalnik; Eva Scheuba; Georg Schneditz; Gerolf Schweintzger; Edith Sterniczky; Ellen Zechner; Almuthe C Hauer; Christoph Högenauer; Karl Martin Hoffmann Journal: Medicine (Baltimore) Date: 2017-08 Impact factor: 1.889