Scales Charles D, Fein Steve, Muir Andrew J, Rockey Don C
Division of Gastroenterology, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
J Clin Gastroenterol. 2006 Nov-Dec;40(10):913-8. doi: 10.1097/01.mcg.0000225674.14594.9f.
The objective of our investigation was to examine the clinical utilization of digital rectal examination (DRE) and fecal occult blood testing (FOBT) at hospital admission.
DRE at the time of hospital admission is frequently accompanied by FOBT. However, the utility of DRE with FOBT in this setting is unknown.
The study cohort comprised consecutive admissions to an internal medicine service over a 3-month period. Patient characteristics were compared for subjects by DRE performance and FOBT result. Follow-up endoscopic procedures within 1 year of admission were recorded.
Complete data were available for 806 of 832 patients (96.9%). Three hundred forty eight patients underwent DRE on admission (43.2%). Patients undergoing DRE/FOBT were older (mean age 60.4+/-18.4 y vs. 55.0+/-19.6 y, P<0.001). Patients with gastrointestinal (GI) bleeding symptoms (relative risk 11.2, 95% confidence interval 5.47-23.0) or a past history of GI bleeding (relative risk 2.98, 95% confidence interval 1.93-4.58) were more likely to undergo DRE/FOBT. Among 130 (37.4%) patients with a positive FOBT, 72 (51.6%) had no history of GI bleeding symptoms; these patients were substantially less likely to undergo follow-up examination(s) than patients with a positive FOBT and a history of GI bleeding symptoms (30.6% vs. 82.8%, P<0.001).
In this cohort, patients with a past history of GI disease or symptoms were more likely to undergo FOBT. Follow-up evaluation of positive FOBT in the absence of GI bleeding symptoms was very low. Low utilization and follow-up rates may limit the utility of admission DRE with FOBT for cancer screening.
我们调查的目的是研究入院时直肠指检（DRE）和粪便潜血试验（FOBT）的临床应用情况。
入院时进行直肠指检常常会同时进行粪便潜血试验。然而，在这种情况下直肠指检联合粪便潜血试验的效用尚不清楚。
研究队列包括内科在3个月期间连续收治的患者。根据直肠指检结果和粪便潜血试验结果对患者特征进行比较。记录入院1年内的后续内镜检查情况。
832例患者中有806例（96.9%）获得了完整数据。348例患者入院时接受了直肠指检（43.2%）。接受直肠指检/粪便潜血试验的患者年龄更大（平均年龄60.4±18.4岁 vs. 55.0±19.6岁，P<0.001）。有胃肠道（GI）出血症状的患者（相对风险11.2，95%置信区间5.47 - 23.0）或有胃肠道出血既往史的患者（相对风险2.98，95%置信区间1.93 - 4.58）更有可能接受直肠指检/粪便潜血试验。在130例（37.4%）粪便潜血试验呈阳性的患者中，72例（51.6%）没有胃肠道出血症状史；与有胃肠道出血症状史且粪便潜血试验呈阳性的患者相比，这些患者接受后续检查的可能性要低得多（30.6% vs. 82.8%，P<0.001）。
在这个队列中，有胃肠道疾病或症状既往史的患者更有可能接受粪便潜血试验。在没有胃肠道出血症状的情况下，对粪便潜血试验阳性的后续评估非常少。低利用率和低随访率可能会限制入院时直肠指检联合粪便潜血试验用于癌症筛查的效用。
