Clinical Review
A Call for a Reconsideration of the Use of Fecal Occult Blood Testing in Emergency Medicine

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Abstract

Background

Fecal occult blood testing (FOBT) was developed to detect microscopic bleeding caused by colorectal neoplasms. The role of FOBT in the emergency department (ED) is typically used for 5 different clinical workups: trauma, anemia, syncope, hypotension, and before the administration of systemic anticoagulants or thrombolytics.

Objective

We scrutinized the literature to assess the utility of FOBT for its 5 most common applications in the emergent setting.

Discussion

Logic and clinical evidence advocating for FOBT usage in the aforementioned situations are lacking. The test itself requires specific drug and dietary restrictions that are often violated or never met when patients present to the ED with acute pathologies. In addition, the poor sensitivity and specificity of the test in these scenarios dictate that neither a negative nor positive FOBT should change the subsequent clinical workup of patients presenting to the ED.

Conclusion

Clinical decision making should seldom be predicated on the results of a FOBT in the ED setting.

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.

Section snippets

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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