West Virginia University - Camden Clark Medical Center Parkersburg, WV
Introduction: Fecal occult blood tests (FOBTs) have been used as a tool for detecting occult blood in stool for colon cancer screening. Increasingly, FOBT has been utilized by clinicians to detect gastrointestinal (GI) bleeding in the hospital setting without evidence supporting its use. Furthermore, a false positive FOBT can lead to excessive patient harm in the form of unnecessary testing, patient anxiety, prolonged hospital stay, and financial hardship. In this study, we looked at the use of FOBTs, relevant specialist consults, and further endoscopic interventions in the inpatient setting.
Methods: Our search criteria included patient demographics, length of stay, admission diagnosis, specialty consulted, FOBT ordering provider, FOBT results, intervention performed, and total blood volume ordered. Patient data was gathered using Epic Workbench. Data were analyzed using SPSS. Frequencies of age, sex, race, and length of stay were calculated. Descriptive statistics were obtained to compare FOBT results with the number of procedures and specialistconsults. Pearson chi-square was used in the analysis of statistical significance.
Results: Over one year, a total of 742 patients received a FOBT while inpatient: 411 females and 333 males; predominantly white (97.3%) with a median age of 71. A total of 433 FOBTs were positive, of which 27 resulted in a colonoscopy and 46 in gastroscopy. Consults to specialty services were placed on 222 positive FOBT results and 187 negative FOBT results. Overall, FOBT did have a significant impact on whether an invasive intervention, such as colonoscopy or gastroscopy, was performed (p < 0.001). FOBT results were not statistically associated with consults placed (p < 0.5).
Discussion: Despite questionable benefits, the use of FOBTs has extended to inpatient and emergency department settings. Reasons for use included anemia, GI bleeds, abdominal pain, melena, and emesis. Two studies looked at the use of FOBTs in the community hospital setting and both found that FOBTs were used for non-evidence-based indications and did not offer any clinical benefit. Data analysis from our study revealed that of the 433 patients with a positive FOBT, only 73 did underwent an intervention. Consequently, the results of a FOBT do not appear to play a large role in deciding further intervention. In order to increase patient benefit and decrease healthcare burden, we plan to further this work by implementing provider education on the uses of FOBT and reporting on the color of stool samples.
