Use and abuse of faecal occult blood tests in an acute hospital inpatient setting

Friedman, Antony; Chan, Annie On On; Chin, Louis; Deen, A; Hammerschlag, Gary; Lee, M; Liddell, Jeffrey R.; Loh, Khai Lee; Moore, Edwina C.; Ng, J; Gibson, Peter R.

doi:10.1111/j.1445-5994.2009.02149.x

Cited by 35 publications

(44 citation statements)

References 10 publications

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“…A study performed in a hospital setting in Australia also detailed gross misuse of gFOBT. 17 gFOBT were requested in clinically inappropriate situations without consideration of possible confounding factors, often leading to inappropriate clinical decisions and additional costs to the hospital and patient: it was concluded that gFOBT had no utility in an acute hospital setting. An accompanying editorial commented: 'The study shows how poor use of technology generates ant-like activity of limited benefit that drives the misallocation of resources, and leads to substandard non-evidencebased patient care'.…”

Section: Introductionmentioning

confidence: 99%

A future for faecal haemoglobin measurements in the medical laboratory

Fraser

2012

Ann Clin Biochem

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Guaiac-based faecal occult blood tests (gFOBT) are still used in asymptomatic population bowel screening programmes but are being replaced by faecal immunochemical tests (FIT) for haemoglobin. gFOBT have many well-documented disadvantages and there is little evidence for their use in assessment of the symptomatic. Many laboratories have eliminated gFOBT from their approved repertoires by invoking the authoritative published guidelines. Data continue to accumulate that gFOBT are obsolete. FIT are available in two formats, qualitative and quantitative, the latter having advantages that the faecal haemoglobin concentrations are measured and cut-off concentrations that stimulate further investigation can be user-defined. There is growing evidence that FIT would be useful in a spectrum of clinical settings in addition to screening. All laboratories should have FIT in their existing repertoire. For some uses, qualitative FIT would be adequate. However, much evidence has accumulated that measurements of faecal haemoglobin concentrations are beneficial for the assessment of both disease severity and the future risk of colorectal neoplasia. Interpretation requires appreciation that faecal haemoglobin concentrations are higher in men than women and rise with age. It might well be that risk scoring systems that take gender and age into account, possibly with other factors including symptoms, will benefit individuals. Laboratories should consider how quantitative faecal haemoglobin measurements could be brought into routine practice and included in their forward planning. External quality assessment is needed. Specialists in laboratory medicine are urged to play a significant role in the research and development still required to make this a truly mature investigation.

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Section: Introductionmentioning

confidence: 99%

A future for faecal haemoglobin measurements in the medical laboratory

Fraser

2012

Ann Clin Biochem

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“…have previously shown that faecal occult blood test (FOBT) is performed for inappropriate reasons in acute hospital settings in Australia. Such testing also affected patients’ management adversely, either by leading to inappropriate or delayed referral for endoscopic investigation …”

Section: Discussionmentioning

confidence: 99%

Inpatient iron deficiency detection and management: how do general physicians and gastroenterologists perform in a tertiary care hospital?

Fazal

Andrews

Thomas

et al. 2017

Internal Medicine Journal

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“…Frequent diarrhea can irritate the anal verge and cause minor bleeding from anal fissures or hemorrhoids. 3 Obviously, the diagnostic workup should focus on finding and eliminating the cause of diarrhea rather than embarking on an endoscopic search for a potential GI bleeding site.…”

Section: Unfocused Goals and Irrelevant Testsmentioning

confidence: 99%