Use and abuse of fecal occult blood tests: a community hospital experience

Abstract

Background The Fecal Occult Blood Test (FOBT) is one of the diagnostic modalities indicated for screening patients for Colorectal Cancer (CRC). Despite being approved only for screening for CRC, numerous studies in the past have illustrated misuse of the FOBT. We examined utilization of the FOBT for patients admitted to a community teaching hospital. Methods The study was conducted at Saint Joseph Hospital, Chicago USA. A retrospective review of Electronic Medical Records (EMRs) of patients admitted from January 2016 to December 2017 was performed. Results We reviewed the EMRs of 729 patients who received the stool testing for occult blood (FOBT). All tests (100%) were carried out for purposes other than CRC screening. Anemia (38%) was the most common reason documented for carrying out the FOBT. Further, 88% of the tests were ordered on patients who either did not fulfill CRC screening criteria or had other contraindications for testing. Usage of contraindicated medication was the most important factor (58% of patients) that made the candidates ineligible for testing. A total 73 Colonoscopies were ordered for patients who received the test inappropriately with a resulting low yield (0.47%) of CRC diagnosis. Conclusion The stool occult blood test continues to be utilized for reasons other than CRC screening. Majority of patients who underwent the test were not suitable candidates due to the presence of contraindications for testing. Unsuitable FOBT testing led to further unnecessary investigations.

A Case for Abandoning Inpatient Fecal Occult Blood Testing

“…Because of false positive tests, patients will be referred for unnecessary endoscopy and therefore have exposure to unnecessary risk. One recent study found a large burden of inappropriate testing leading to unnecessary colonoscopies with an estimated rate of only one case of CRC diagnosed for every 214 patients inappropriately tested with FOBT [2].…”

“…The test characteristics are accompanied by false positives and negatives, increased direct and indirect costs, delays in appropriate consultations or endoscopy, increase length of hospital stays, unnecessary procedures, and results that do not change management. Inappropriate use of FOBT can lead to both overuse and underuse of endoscopy [ 2 - 5 ].…”

“…Several studies on the utility of inpatient gFOBT have found that the initial rationale for testing are also indications for endoscopy and FOBT results should not determine the need for endoscopy [ 2 - 5 , 7 ]. Uninvestigated iron deficiency anemia (IDA) and overt GI bleeding are both appropriate indications for endoscopy and are two of the most common reasons for obtaining a gFOBT in most audit studies.…”

“…Both gFOBT and FIT are recommended screening tests for colorectal cancer (CRC) in the outpatient setting [1]. Although FOBTs are currently Food and Drug Administration (FDA) approved only for CRC screening, there is now widespread inappropriate use in the hospital setting as a diagnostic test [2]. Here we present a brief case and a discussion arguing against the utility of FOBT as a diagnostic test.…”

Utilization of Fecal Occult Blood Testing and Its Impact on Endoscopic Procedures in Hospitalized Patients

“…[2] While the utility of FOBTs for colorectal cancer screening in ambulatory settings is established, such testing continues to be used in the inpatient setting for the evaluation of anemia and suspected gastrointestinal bleeding. [3,4] Anemia during hospitalization is common [5] and often triggers an evaluation for GI bleeding including FOBTs. We undertook a descriptive evaluation of patients at our institution, who developed anemia and in whom an FOBT was performed, to gain insights on the utilization of these tests and their impact on management decisions.…”