Bloody Faecal Matter

[ironjustice]

This says .. "no matter how much you ENJOY this" it is
"inappropriate"
and "costs the patient and health care system substantial amounts of
precious
cash" ..

THE USE AND ABUSE OF FAECAL OCCULT BLOOD TESTS IN
AN ACUTE HOSPITAL INPATIENT SETTING.
Friedman A, Chan A, Chin LC, Deen A, Hammerschlag G,
Lee M, Liddell J, Loh K, Moore E, Ng J, Gibson PR
Intern Med J 2009 Dec 15.

ABSTRACT
Background:
The role of the faecal occult blood test (FOBT) is untested.
Aims:
To define the use of FOBT in a general hospital setting and
to determine its influence on patient management.
Methods:
Case notes and laboratory reports were retrospectively
reviewed in all FOBTs performed in 2006 across three acute
hospitals, with specific reference to clinical setting,
indication, influence over clinical decision making and
management.
Both guaiac and immunological tests were performed on all
specimens.
Results:
330 patients aged 2-104 (mean 74) years, 47% men, had 461
tests performed.
A positive result was recorded in one or both tests in 64%
of patients.
Evidence of dietary restriction was found in only eight
(2%) of patients.
218 (66%) patients took one or more medications that could
have caused a false positive result.
Indications were mostly for overt or suspected
gastrointestinal blood loss with or without anaemia and/or
iron deficiency but 5% were for non-bloody diarrhoea and 3%
screening for colorectal cancer.
Patient care was adversely affected or delayed in 54 patients
(16%), mostly due to the result being the stimulus for the
decision to refer or not for endoscopy.
Only one was considered appropriate as a screening test for
colorectal cancer.
Conclusions:
The FOBT was applied in clinically inappropriate settings
without consideration to confounding issues, and often led
to inappropriate clinical decisions with considerable cost
to hospital and patient.
There is no place for FOBT in an acute hospital setting.

Internal medicine journal [Intern Med J]

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Tom

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