This pilot study examined the utility of a routinely performed digital rectal examination (DRE) in pediatric trauma patients. A prospective convenience sample of patients 0 to 18 years of age presenting to the pediatric emergency department of an urban level I trauma center with a history of trauma to the spine or trunk was enrolled. An abnormal DRE was defined by the presence of gross or occult blood, decreased sphincter tone, compromised integrity of the rectal vault, or a high riding prostate. We defined DRE-identifiable injuries as spinal injury, pelvic fracture, rectal or other lower intestinal injury, and urethral injury. One hundred thirty-five patients were studied; 8 patients had DRE-identifiable injuries. The sensitivity and negative predictive value of the physical examination with and without the DRE were equivalent. Routine performance of the digital rectal examination may not improve the identification of serious injury during the secondary survey in pediatric trauma patients.