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113 THE USE OF FECAL OCCULT BLOOD TESTING (FOBT) ON AN INPATIENT POPULATION PH Krongold1, H Fraser2, A Rostom1, E MacKay2, S Coderre1 BACKGROUND: FOBT is a validated test in outpatients for colon cancer screening. Its use for such screening on an inpatient population is not validated. The sensitivity of FOBT ranges widely, and is estimated at 70% at best. In cases of overt/clinical suspicion of GI bleeding or in iron deficiency anemia (IDA) a negative test is not adequate to rule out a GI lesion. The FOBT should not be considered part of such an evaluation as a positive test is non-specific and redundant because further evaluation should be used regardless of result. A negative test may impart a false sense of thorough evaluation of the GI tract and therefore result in missed lesions. The use of this test incurs a cost to the region without adding value to the evaluation and possibly hindering it.
1Division of Gastroenterology; 2Division of General Medicine, University of Calgary, Calgary, Alberta
AIMS: To describe the use of FOBT in an inpatient population including patient characteristics, rationale for testing and impact of the test on further investigations. To determine the cost of using FOBT in this population and cost savings if the test was used more appropriately.
METHODS: A retrospective audit of FOBT use in an inpatient population will be performed at the three adult hospitals in the Calgary Health Region. Data will be collected using the Lab Services database and a chart review.
RESULTS: Preliminary data shows that none of the patients undergoing FOBT were on a restricted diet and one-half of the patients were on anti-platelet agents/anti-coagulants at the time of the test. Rationale for testing included: overt/strong clinical suspicion of GI bleeding (36%), anemia (36%), clinical suspicion for colon cancer (14%), and IDA (7%). For patients that had overt/strong clinical suspicion of GI bleeding, 80% had a positive test. For overt/suspected GI bleeding or IDA, none of the patients were referred to GI subsequent to the test results (positive or negative). Of the patients with strong clinical suspicion of colon cancer, FOBT was negative and did not result in referral for GI evaluation.
CONCLUSIONS: Based on preliminary data, FOBT is being used on inpatients for non-validated reasons. The testing is frequently done without restriction of diet or medications. The test is often used for patients that should be formally evaluated by gastroenterology. Results of the tests (positive/negative) are often not documented and do not appear to impact on decisions such as referrals to GI or further investigations.