Clinical ReviewA Call for a Reconsideration of the Use of Fecal Occult Blood Testing in Emergency Medicine
Introduction
For decades, the evaluation of certain complaints in the emergency department (ED) has routinely included a rectal examination followed by testing for microscopic amounts of blood in the stool using fecal occult blood tests (FOBTs). Our objective is to scrutinize the utility and rationale of this practice. We are not questioning the gross examination of stool, whether by digital rectal examination or otherwise; instead, we will examine the evidence regarding whether there is added value to the bedside test for occult fecal blood in the ED setting.
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Discussion
FOBT has value as a population screening tool for colorectal neoplasms because it can detect occult bleeding from sources such as gastrointestinal tumors. When deployed widely and performed correctly, it can lead to earlier detection of colorectal neoplasms, which has been shown to reduce mortality caused by colon cancer (1). An important limitation of FOBT is that it is designed to be performed in a patient's home under specific restrictions pertaining to diet and drug usage. The consumption
Conclusion
In conclusion, FOBT in the ED is an unreliable test of doubtful significance. There is rarely any added diagnostic value in testing normal appearing stool for occult blood. In addition, the results of FOBT in the ED should rarely, if ever, change management in the vast majority of cases. Therefore, the role of FOBT in the emergent setting is marginal, with indication only in select cases. Its routine use in the evaluation of trauma, anemia, syncope, hypotension, and thrombolytic administration
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Chapter 98. Tests for fecal occult blood
Appearances of the stools after the introduction of blood into the cecum
Gut
Cited by (2)
Abdominal Pain: The Differential Diagnosis, Classic Histories, and Diagnosis
2023, Physician Assistant ClinicsCitation Excerpt :A tender or boggy prostate on digital palpation indicates prostatitis.28 Fecal inspection for bright red blood or melena should be performed in the appropriate clinical context; however, fecal occult blood testing is primarily used for outpatient colorectal cancer screening and rarely changes ED management.29 Laboratory tests are useful in select clinical indications (Table 5) but otherwise rarely establish a diagnosis.
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