Abstract
Introduction
Cauda equina syndrome represents the constellation of symptoms and signs resulting from compression of lumbosacral nerve routes. Combined with subjective neurological findings, a reduction in anal tone is an important sign deeming further imaging necessary. Our main objective was to investigate the validity of DRE for assessment of anal tone.
Method
75 doctors completed a questionnaire documenting their grade, speciality and experience in performing DRE. A model anus, using a pressure transducer surrounding an artificial canal, was assembled and calibrated. Participants performed 4 DREs on the model and predicted tone as ‘reduced’ or ‘normal’ (35 and 60 mmHg respectively), followed by a ‘squeeze’ test. 30 healthcare assistants (HCAs) with no training in DRE partook as a control group.
Results
In each attempt 60%, 61%, 63% and 72% of doctors correctly identified the anal tone respectively (average accuracy 64%). HCAs had an identical average accuracy of 64%. 100% of participants correctly felt the squeeze test. For doctors no correlation was found between confidence in assessing anal tone using DRE and a correct result. 71% had received previous training in DRE with 64% of these taught how to assess anal tone.
Conclusion
The results demonstrate that accuracy in assessing anal tone using DRE is limited with overall correctness of 64%. Poor correlation exists between perceived level of skill and study result. Doctors were not significantly more able than HCAs to detect correct tone. Therefore, DRE for the assessment of anal tone is not a wholly accurate tool.
No conflicts of interest
No funding obtained
This work was presented at BritSpine
