An audit of the utility of in-patient fecal occult blood testing

Virender K. Sharma, Sri Komanduri, Sanjay Nayyar, Anna Headly, Paul Modlinger, David C. Metz, Vino J. Verghese, Anna Wanahita, Mae F. Go, Colin Howden

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVES: Recent surveys of physician practice have suggested the existence of excessive, inappropriate use of the fecal occult blood test (FOBT). We studied the implementation of this test in hospitalized patients. METHODS: We performed a retrospective chart review of 1000 randomly selected patients who had been discharged from the Medicine service at four teaching hospitals. Patient demographics, clinical presentation, presence or absence of overt GI bleeding, and use of medications that might affect the FOBT were recorded. Reviewers assessed whether patients who had FOBT would have been candidates for colon resection if asymptomatic colon cancer had been found. RESULTS: Digital rectal examination was documented in 44.8% of patients; the findings were recorded in only 9%. A total of 421 patients had FOBT on admission, usually on stool obtained at digital rectal examination. Of the patients with a positive FOBT, 17% had active GI bleeding. Only 41.1% of patients with a positive FOBT were referred to the gastroenterology service. In 70.5% of patients, FOBT could be considered inappropriate because of factors such as age, active GI bleeding, or use of aspirin or other nonsteroidal anti-inflammatory drugs. CONCLUSIONS. The FOBT, which is validated only for colorectal cancer screening, is often performed inappropriately in patients admitted to the hospital. This test should be restricted in hospital practice. It would be preferable to identify patients who are appropriate candidates for colorectal cancer screening at the time of hospital discharge and to advise them about the appropriate performance of the FOBT at home.

Original languageEnglish (US)
Pages (from-to)1256-1260
Number of pages5
JournalAmerican Journal of Gastroenterology
Volume96
Issue number4
DOIs
StatePublished - Apr 28 2001
Externally publishedYes

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Occult Blood
Hematologic Tests
Digital Rectal Examination
Hemorrhage
Early Detection of Cancer
Colorectal Neoplasms
Gastroenterology
Teaching Hospitals
Colonic Neoplasms
Aspirin
Colon
Anti-Inflammatory Agents
Medicine
Demography

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Sharma, V. K., Komanduri, S., Nayyar, S., Headly, A., Modlinger, P., Metz, D. C., ... Howden, C. (2001). An audit of the utility of in-patient fecal occult blood testing. American Journal of Gastroenterology, 96(4), 1256-1260. https://doi.org/10.1016/S0002-9270(01)02272-9

An audit of the utility of in-patient fecal occult blood testing. / Sharma, Virender K.; Komanduri, Sri; Nayyar, Sanjay; Headly, Anna; Modlinger, Paul; Metz, David C.; Verghese, Vino J.; Wanahita, Anna; Go, Mae F.; Howden, Colin.

In: American Journal of Gastroenterology, Vol. 96, No. 4, 28.04.2001, p. 1256-1260.

Research output: Contribution to journalArticle

Sharma, VK, Komanduri, S, Nayyar, S, Headly, A, Modlinger, P, Metz, DC, Verghese, VJ, Wanahita, A, Go, MF & Howden, C 2001, 'An audit of the utility of in-patient fecal occult blood testing', American Journal of Gastroenterology, vol. 96, no. 4, pp. 1256-1260. https://doi.org/10.1016/S0002-9270(01)02272-9
Sharma VK, Komanduri S, Nayyar S, Headly A, Modlinger P, Metz DC et al. An audit of the utility of in-patient fecal occult blood testing. American Journal of Gastroenterology. 2001 Apr 28;96(4):1256-1260. https://doi.org/10.1016/S0002-9270(01)02272-9
Sharma, Virender K. ; Komanduri, Sri ; Nayyar, Sanjay ; Headly, Anna ; Modlinger, Paul ; Metz, David C. ; Verghese, Vino J. ; Wanahita, Anna ; Go, Mae F. ; Howden, Colin. / An audit of the utility of in-patient fecal occult blood testing. In: American Journal of Gastroenterology. 2001 ; Vol. 96, No. 4. pp. 1256-1260.
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abstract = "OBJECTIVES: Recent surveys of physician practice have suggested the existence of excessive, inappropriate use of the fecal occult blood test (FOBT). We studied the implementation of this test in hospitalized patients. METHODS: We performed a retrospective chart review of 1000 randomly selected patients who had been discharged from the Medicine service at four teaching hospitals. Patient demographics, clinical presentation, presence or absence of overt GI bleeding, and use of medications that might affect the FOBT were recorded. Reviewers assessed whether patients who had FOBT would have been candidates for colon resection if asymptomatic colon cancer had been found. RESULTS: Digital rectal examination was documented in 44.8{\%} of patients; the findings were recorded in only 9{\%}. A total of 421 patients had FOBT on admission, usually on stool obtained at digital rectal examination. Of the patients with a positive FOBT, 17{\%} had active GI bleeding. Only 41.1{\%} of patients with a positive FOBT were referred to the gastroenterology service. In 70.5{\%} of patients, FOBT could be considered inappropriate because of factors such as age, active GI bleeding, or use of aspirin or other nonsteroidal anti-inflammatory drugs. CONCLUSIONS. The FOBT, which is validated only for colorectal cancer screening, is often performed inappropriately in patients admitted to the hospital. This test should be restricted in hospital practice. It would be preferable to identify patients who are appropriate candidates for colorectal cancer screening at the time of hospital discharge and to advise them about the appropriate performance of the FOBT at home.",
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