Diagnostic fecal occult bloodtesting in hospitalized and emergency department patients: Time for change?

Objective: To examine the use of fecal occult blood testing in inpatients and in those presenting to the emergency department. Methods: We retrieved all fecal occult blood tests (FOBTs) conducted over a 3 year period, gastrointestinal endoscopic studies, and diagnoses of digestive-tract malignant neoplasms. Scheduling reasons and procedure results for all gastrointestinal endoscopies scheduled within 30 days after the FOBT result became available were recorded. Results: A total of 5028 FOBTs were obtained during the 3-year period. Half of the diagnostic endoscopic procedures (n = 957) completed within 30 days of FOBT followed a negative test result. The few reasons for scheduling endoscopic procedures included a positive FOBT result. During follow-up, 17 new diagnoses of digestive-tract malignant neoplasms were made, and 8 of 17 patients had 1 or more positive FOBT result. Conclusions: The results of FOBTs, by themselves, are rarely used for patient management. Eliminating the routine diagnostic use of FOBTs in those settings would not compromise patient care.