Use of Fecal Occult Blood Testing in Hospitalized Patients: Results of an Audit

Ip, Stephen; Sokoro, AbdulRazaq; Kaita, Lisa; Ruiz, Claudia; McIntyre, Elaine; Singh, Harminder

doi:10.1155/2014/697103

Cited by 18 publications

(20 citation statements)

References 6 publications

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“…Previous studies describing the role of FOBT in the inpatient setting highlight the potential for FOBT to influence inappropriate clinical decision-making. [ 2 4 5 6 7 ] It has also been suggested that implementation of FOBT in the inpatient setting contributes to increased hospital length of stay and increased medical costs. [ 7 ] Yet, FOBT is commonly used in the acute hospital setting and its influence on clinical decision-making, patient management, length of stay, and medical costs have not been fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

Utilization of fecal occult blood test in the acute hospital setting and its impact on clinical management and outcomes

Mosadeghi

Ren

Catungal

et al. 2016

Journal of Postgraduate Medicine

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Background:Despite lack of evidence supporting the use of fecal occult blood test (FOBT) in the acute hospital setting, FOBT is commonly used in the inpatient setting for reasons other than colorectal cancer (CRC) screening.Aims:To evaluate practice trends in utilizing FOBT on inpatients and its impact on affecting clinical management and outcomes.Materials and Methods:A cross-sectional study of consecutive adult patients undergoing FOBT from January 1, 2011 to December 31, 2011 during an acute medical admission at a large urban safety net hospital was performed. Indications for FOBT, and the impact of FOBT results on endoscopic procedures performed and clinical outcomes were assessed. The number of inpatient endoscopic procedures before and after discontinuing inpatient FOBT was also assessed.Results:A total of 207 inpatient FOBTs were performed in 2011. The most common reason cited for FOBT was anemia (36%, n = 74) followed by gastrointestinal (GI) bleeding (27%, n = 55). Interestingly, 23% (n = 47) of the patients undergoing inpatient FOBT had overt GI bleeding. As expected, patients with positive FOBT were significantly more likely to undergo endoscopic examinations (P < 0.01). After discontinuing the availability of inpatient FOBT, patients were less likely to undergo endoscopic examinations [odds ratio (OR) 0.80, 95% confidence interval (CI) 0.75-0.85].Conclusion:Inappropriate utilization of FOBT in the inpatient setting is common, even when the indication does not support its use. Setting limitations on inpatient FOBT may reduce the inappropriate utilization of inpatient FOBT. Quality improvement initiatives are needed to educate clinicians on the appropriate use of FOBT, which is primarily for average risk CRC screening.

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Section: Introductionmentioning

confidence: 99%

Utilization of fecal occult blood test in the acute hospital setting and its impact on clinical management and outcomes

Mosadeghi

Ren

Catungal

et al. 2016

Journal of Postgraduate Medicine

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“…6,13 Although there is data suggesting that advanced age and mean corpuscular volume may predict a positive endoscopic evaluation in patients with iron deficiency anemia, 14,15 there is limited data on which hospitalized patients with anemia and a positive fecal occult blood test (FOBT) have either positive findings on endoscopic evaluation or need endoscopic intervention. In this prospective study, we demonstrate that hospitalized patients with concern for occult GIB who have active malignancy and lower admission hemoglobin levels are more likely to have a positive source of GIB detected on endoscopic evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…4 Because of its false positive results, inpatient guaiac testing commonly leads to negative endoscopic testing, 4,5 and has been shown to have little beneficial impact on inpatient clinical management. 6 In fact, despite endoscopic evaluation with upper esophagogastroduodenoscopy (EGD) and colonoscopy, the source of bleeding can remain undetected in patients with occult GIB in up to 52% of patients. 7 In such cases where initial endoscopic evaluation is unrevealing, current guidelines recommend consideration of further studies such as capsule endoscopy and enteroscopy.…”

Section: Introductionmentioning

confidence: 99%

Predictors of positive endoscopic findings in hospitalized patients with occult gastrointestinal bleeding

Sengupta

Tapper

Patwardhan

et al. 2015

Gastroenterol Insights

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Anemia with occult gastrointestinal bleeding (OGIB) is a common reason for inpatient gastroenterology consultation and endoscopy. However, the utility of inpatient endoscopy in this setting is unclear. The aim of this paper is to determine variables that predict positive endoscopic examinations for inpatients presenting with anemia and OGIB. We performed a prospective observational study of consecutive hospitalized patients between March 2013 and April 2014 with anemia and OGIB. For patients undergoing inpatient endoscopic evaluation, logistic regression was used to determine which variables were associated with detecting etiology of OGIB. An occult bleeding score (OBS) was created using receiver operating characteristics and area under the curve (AUC) analysis to predict detection of bleeding source and need for endoscopic intervention. Of the 74 patients identified, 55 (74%) underwent endoscopic evaluation, of whom 28 patients had a source of OGIB identified. Patients with malignancy (OR 7.25, 95%CI 1.06-144) were more likely to have a bleeding source identified on endoscopy, whereas patients with higher admission hemoglobin levels were less likely to have a detected source (OR 0.62, 95%CI 0.41-0.86). The OBS was constructed by assigning a point each for malignancy and admission hemoglobin <8.2 g/dL. The OBS predicted detection of etiology of bleeding and endoscopic intervention with an AUC of 0.79 and 0.75. The yield of endoscopy in determining a bleeding source in patients with OGIB is significant particularly in patients with malignancy or a low hemoglobin level. A simple score can assist in determining whether inpatient endoscopy is warranted in this population.

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“…In one study, only 34% of hospitalized patients with a positive FOBT underwent further GI studies, with the majority of those patients (60%) receiving endoscopy before the results of the FOBT were known. 18 In another study of 201 FOBTs performed on hospitalized patients, those with negative results underwent further GI evaluation at a higher rate than those with positive results (41% vs 38%). 8 This aligns with a study that revealed the majority of patients suspected of having a GI bleed underwent endoscopic evaluation regardless of the FOBT result.…”

Section: Why Fobt Is Not Helpful For Evaluation Of Inpatients With Sumentioning

confidence: 98%

Fecal Occult Blood Testing in Hospitalized Patients with Upper Gastrointestinal Bleeding

Mathews

Ratcliffe

Sehgal

et al. 2017

Journal of Hospital Medicine

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Use of Fecal Occult Blood Testing in Hospitalized Patients: Results of an Audit

Abstract: The present study suggests that FOBT results in hospitalized patients may have little beneficial impact on clinical management. Hospital laboratories may be better served in directing resources to other tests.

Cited by 18 publications

References 6 publications

Utilization of fecal occult blood test in the acute hospital setting and its impact on clinical management and outcomes

Utilization of fecal occult blood test in the acute hospital setting and its impact on clinical management and outcomes

Predictors of positive endoscopic findings in hospitalized patients with occult gastrointestinal bleeding

Fecal Occult Blood Testing in Hospitalized Patients with Upper Gastrointestinal Bleeding

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