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Comparison of Emergency Physicians' and Hospitalists' Attitudes Toward Fecal Occult Blood Testing in Gastrointestinal
1Saint Joseph's University Medical Center, Department of Emergency Medicine, Paterson, New Jersey.
Insights
Emergency physicians doubt the utility of the guaiac fecal occult blood test (gFOBT) for gastrointestinal bleeding, while hospitalists use it more but find it rarely changes management. Re-evaluation of gFOBT in acute care is needed.
Area of Science:
- Gastroenterology
- Clinical Medicine
- Diagnostic Testing
Background:
- The guaiac fecal occult blood test (gFOBT) is commonly used in emergency departments (ED) for suspected gastrointestinal (GI) bleeding.
- However, gFOBT has limitations in sensitivity and specificity, leading to potential diagnostic inaccuracies.
Purpose of the Study:
- To evaluate current practices and perceptions of emergency physicians and hospitalists regarding the utility of gFOBT in the ED setting.
- To assess the impact of gFOBT on clinical decision-making and patient management.
Main Methods:
- A multicenter survey was conducted among attending physicians in the ED and hospitalists.
- Participants rated their agreement with statements about gFOBT utility on a 5-point Likert scale.
Main Results:
- Emergency physicians were significantly less likely than hospitalists to consider gFOBT important for GI bleeding evaluation (31% vs 67%).
- While over half of emergency physicians perform the test, hospitalists frequently request it but rarely find it changes management (33%).
- Hospitalists indicated they would admit patients with suspected GI bleeding regardless of gFOBT results.
Conclusions:
- Widespread use of gFOBT persists despite skepticism from emergency physicians.
- Distinct attitudes exist between ED and hospitalist teams regarding gFOBT's clinical impact.
- Re-evaluation of gFOBT in acute care settings and improved inter-departmental communication are recommended.
Introduction:
The guaiac fecal occult blood test, originally designed for colorectal cancer screening, is frequently used in emergency departments (ED) to detect occult gastrointestinal (GI) bleeding. However, the test has low sensitivity and specificity, leading to potential false positives and negatives. This study evaluates the current practices and perceptions of emergency physicians and hospitalists regarding the utility of the guaiac test in the setting of suspected GI bleeding in the ED.
Objective:
Our primary aim in this study was to evaluate the current practice and views of emergency physicians and hospitalists on the utility of the stool guaiac test in the ED.
Methods:
We conducted a multicenter survey from January 3-April 3, 2024, across four hospital systems, targeting attending physicians in the ED and hospitalists. Participants were asked to rate their agreement with statements about the stool guaiac test on a scale of 1 (strongly disagree) to 5 (strongly agree).
Results:
Response rates were 47/93 (50.5%) for emergency attendings and 9/18 (50%) for hospitalists. Emergency attendings were significantly less likely than hospitalists to agree that stool guaiac testing is important for evaluating GI bleeding (31% vs 67%, P < .001). More than half of emergency attendings (55%) reported often performing the test, while 44% of hospitalists reported frequently requesting it before accepting a patient. Although 70% of emergency attendings believed that guaiac results influence hospitalists' admission decisions (P = .02), 67% of hospitalists stated they would accept a patient with suspected GI bleeding even without a result. Despite rating the test as important, only 33% of hospitalists felt that stool guaiac testing frequently changes management during hospitalization. Overall, the groups showed distinct attitudes regarding the utility and impact of stool guaiac testing.
Conclusion:
The guaiac fecal occult blood test remains widely used despite skepticism among emergency attendings regarding its importance. Hospitalists were more likely to request the test but acknowledged it rarely changes patient management. These findings highlight the need for re-evaluation of guaiac testing in acute care settings and improved communication between ED and inpatient teams. Further research should explore the clinical impact of removing routine stool guaiac testing.
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