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Canadian Journal of Gastroenterology and Hepatology
Volume 28, Issue 9, Pages 489-494
http://dx.doi.org/10.1155/2014/697103
Original Article

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

Stephen Ip,1 AbdulRazaq AH Sokoro,1,2,3 Lisa Kaita,4 Claudia Ruiz,4 Elaine McIntyre,4 and Harminder Singh1,5,6,7

1Department of Medicine, University of Manitoba, Canada
2Department of Pathology, University of Manitoba, Canada
3Diagnostic Services of Manitoba, Canada
4Winnipeg Regional Health Authority, Canada
5Department of Community Health Sciences, University of Manitoba, Canada
6Department of Hematology and Oncology, CancerCare Manitoba, Canada
7University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada

Received 3 May 2014; Accepted 1 August 2014

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: The fecal occult blood test (FOBT), widely used as a colorectal cancer screening tool, continues to be used in hospitalized patients. However, the utility of this test for hospitalized patients is unclear.

OBJECTIVE: To assess FOBT use in a large urban regional health authority.

METHODS: Reports of all FOBTs performed between April 1, 2011 and March 30, 2012 from two academic and four community hospitals in Winnipeg (Manitoba) were extracted. Of 650 hospitalizations with a positive FOBT result and 1254 with a negative FOBT result, random samples of 230 and 97 charts, respectively, were reviewed. Information including demographics, admission diagnos(es), indication(s) for ordering the FOBT and clinical management was extracted.

RESULTS: Thirty-four percent (650 of 1904) of hospitalizations with an FOBT had a positive FOBT result. Family medicine physicians ordered approximately one-half of the reviewed FOBTs. The most common indication for ordering an FOBT was anemia. Of those with a positive FOBT, 66% did not undergo further gastrointestinal investigations. Of those with a positive FOBT and overt gastrointestinal bleeding and/or melena who underwent endoscopy, 60% had their endoscopy performed before the FOBT result being reported while 38% underwent their endoscopy ≥3 days after the stool sample was collected. There were minimal differences in clinical practices between academic and community hospitals.

CONCLUSIONS: 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.