C0324 - Diagnostic Utility of Inpatient Fecal Occult Blood Testing

Shreya Narayanan, MD¹, Carlos Bertran-Rodriguez, MD¹, Charles P. Cavalaris, MD¹, Nicole L. Miller, MD¹, Chanlir Segarra, MD¹, Wesley Wright, MD¹, Ambuj Kumar, MD, MPH¹, Jade S. Edwards, MD², Rene D. Gomez-Esquivel, MD^3
1University of South Florida Morsani College of Medicine, Tampa, FL; ²Cascade Gastroenterology, Bend, OR; ³USF Health Morsani College of Medicine, Tampa, FL

Introduction: The fecal occult blood test (FOBT) is a screening tool recommended for use in the outpatient setting for detection of colorectal cancer (CRC) in patients at average risk of developing CRC. Use of FOBT in the inpatient setting is not recommended. Furthermore, there is consistent evidence that inpatient testing may be a detriment to patient care. Thus we completed this study with the objective of assessing the diagnostic utility of inpatient fecal occult blood testing.

Methods: In this retrospective cohort study approved by the USF and TGH IRBs, all consecutive adult patients who underwent FOBT between April 2020 and April 2021 in the ER or inpatient settings were eligible for inclusion. Data extracted included patient demographics, relevant medical comorbidities and treatments, indication for FOBT, and need for inpatient GI consultation and endoscopy related to the completion of FOBT.

Results: A total of 826 patients met inclusion criteria. 456 (55.2%) had a negative FOBT and 370 (44.8%) had a positive test. The two most common indications for FOBT were anemia and overt GI bleed (60.4% and 21.9%, respectively). A GI consult was significantly more common in FOBT positive (71.6%) patients versus FOBT negative patients (33.1%; p-value< 0.01). Overall, 85 patients (10.3%) underwent colonoscopy and 182 patients (22.0%) underwent EGD. A positive FOBT resulted in significantly higher rates of EGD (36.2%) compared with negative FOBT (10.5%; p< 0.01). Similarly, the incidence of colonoscopy was also significantly higher with positive FOBT (14.9%) versus with negative FOBT (6.6%; p< 0.01). A potential source of bleeding or anemia was identified in 49.7% of patients with a positive FOBT vs 40% of patients with a negative result (p-value: 0.013). Five patients (3.2%) with a positive FOBT versus two patients with negative FOBT (1.4%) were diagnosed with CRC (p=0.45).

Discussion: The findings of our study show that the diagnostic utility of FOBT in ED or inpatient setting is poor and of low yield. Not only were a minority of patients were subsequently diagnosed with CRC, but FOBT use was also associated with several follow up tests and consults which may be considered significant misuse of valuable time and resources. One potential implication from our findings could be the development of a decision support system in the electronic medical record to guide healthcare professionals in optimal decision making when assessing a patient with suspected bleeding in the ER or inpatient settings.


Disclosures:


Shreya Narayanan, MD¹, Carlos Bertran-Rodriguez, MD¹, Charles P. Cavalaris, MD¹, Nicole L. Miller, MD¹, Chanlir Segarra, MD¹, Wesley Wright, MD¹, Ambuj Kumar, MD, MPH¹, Jade S. Edwards, MD², Rene D. Gomez-Esquivel, MD³. C0324 - Diagnostic Utility of Inpatient Fecal Occult Blood Testing, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.