If you trained or practiced in the last few decades, there’s no doubt you’ve performed hundreds, if not thousands, if not tens of thousands, of fecal occult blood tests. For many years, this has been part of some routine evaluations for suspected gastrointestinal bleeding or anemia without another adequately identified source.
However, this test is pointless, as these folks at Parkland succinctly illustrate. In evaluating the value of the FOBT in the acute clinical setting, they observe two features obviating its utility. First, they argue the test characteristics are utterly inadequate – there are confounders contributing to both false negatives and false positives, leading to either delays or inappropriate interventions. Then, they ultimately note ultimate clinical course depends on the the other presenting features rather than the result of the FOBT.
Specifically, Parkland went from nearly 8,000 FOBT (mostly in the Emergency Department) to zero.
You can too.
“Eliminating in-Hospital Fecal Occult Blood Testing: Our Experience with Disinvestment”
https://www.sciencedirect.com/science/article/pii/S0002934318302195
At last !
I never understood why this test was used in US EDs.
It is not meant to diagnose acute digestive tract bleeds.
I use eyes and rectal digital exam; rarely a gastro-duodenal tube.
I don’t use urine dipstix for blood either: not done for that purpose. Digestive bleeds are visible.
Generally agree. It’s not sensitive enough to not do endoscopy with unexplained anemia, and it’s not specific enough to go fishing for oddly colored stool of uncertain clinical significance.
Some folks on FB did suggest using it in pediatrics to try and reassure parents for bright red stool that is suspected to be food dye.