Do You Bleed? A 1-Year FOBT Case-Series Study

Area of Science:

• Gastroenterology
• Clinical Diagnostics
• Hospital Medicine

Background:

• Fecal occult blood test (FOBT) is approved for colorectal cancer screening.
• Inappropriate use of FOBT for suspected gastrointestinal bleeding (GIB) in hospitals is common.
• The diagnostic efficiency of FOBT in the inpatient setting for GIB is questionable.

Purpose of the Study:

• To investigate the utilization of FOBT for suspected GIB in a hospital setting.
• To evaluate the impact of FOBT on hospitalization length.
• To assess the effect of FOBT on inpatient endoscopy procedures.

Main Methods:

• Retrospective analysis of 678 FOBT cases over 12 months at a tertiary academic medical center.
• Collected data included FOBT results, hemoglobin levels, rectal examinations, endoscopy performance, hospital stay duration, and gastrointestinal lesion identification.
• Correlation of FOBT results with diagnostic outcomes and patient management.

Main Results:

• Positive FOBT results showed weak test sensitivity, with 13.5% of cases having no endoscopic findings.
• FOBT results poorly guided management; only 14.6% of negative FOBT patients underwent endoscopy, and less than 50% of positive FOBT patients were offered procedural evaluation.
• Patients with positive FOBT experienced longer hospitalizations.
• Endoscopy was performed for GIB investigation in critically anemic patients, irrespective of FOBT results.

Conclusions:

• FOBT is inappropriately utilized for GIB investigation in hospitals.
• Inpatient FOBT use is inefficient, leading to unnecessary endoscopies, prolonged hospital stays, and care delays.
• FOBT should be restricted to outpatient settings and avoided for inpatient GIB and anemia evaluations.