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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.