A Call for a Reconsideration of the Use of Fecal Occult Blood Testing in Emergency Medicine

Fecal occult blood testing (FOBT) was developed to detect microscopic bleeding caused by colorectal neoplasms. The role of FOBT in the emergency department (ED) is typically used for 5 different clinical workups: trauma, anemia, syncope, hypotension, and before the administration of systemic anticoagulants or thrombolytics.

We scrutinized the literature to assess the utility of FOBT for its 5 most common applications in the emergent setting.

Logic and clinical evidence advocating for FOBT usage in the aforementioned situations are lacking. The test itself requires specific drug and dietary restrictions that are often violated or never met when patients present to the ED with acute pathologies. In addition, the poor sensitivity and specificity of the test in these scenarios dictate that neither a negative nor positive FOBT should change the subsequent clinical workup of patients presenting to the ED.

Clinical decision making should seldom be predicated on the results of a FOBT in the ED setting.