Denver Health Medical Center, CO, USA.
Ann Emerg Med. 2010 Aug;56(2):135-41. doi: 10.1016/j.annemergmed.2009.12.021. Epub 2010 Jan 8.
We determine whether removing point-of-care fecal occult blood testing from the emergency department (ED) is associated with a decrease in documented digital rectal examinations.
We performed a retrospective observational chart review study examining documented digital rectal examinations, before and after removal of a point-of-care fecal occult blood test, on all adult patients who presented to our ED with chief complaints that were likely to warrant a fecal occult blood test (intervention-sensitive). We studied the 6 months immediately before and after switching from bedside fecal occult blood testing to immunohistochemical laboratory fecal occult blood testing. We compared the results with those from a similar cohort of patients who presented during the same period, with chief complaints that would warrant a digital rectal examination for reasons other than fecal occult blood test (intervention-insensitive).
A total of 4,981 and 5,557 patients met our inclusion criteria during the before and after intervention periods, respectively. We observed an overall reduction of 10% (95% confidence interval [CI] 8% to 12%) in digital rectal examinations in patients with intervention-sensitive chief complaints. The largest relative decreases in digital rectal examinations were observed in patients with chief complaints of abdominal pain, nausea/vomiting, and diarrhea. Smaller decreases were observed in gastrointestinal bleeding, constipation, and rectal problem. There was an overall reduction of 3% (95% CI 0% to 5%) in documented digital rectal examinations in intervention-insensitive chief complaints. After controlling for all covariates, digital rectal examinations decreased in the postintervention period for intervention-sensitive (odds ratio 0.44 [95% CI 0.39 to 0.50]) and, to a lesser extent, for intervention-insensitive (odds ratio 0.67 [95% CI 0.52 to 0.86]) conditions.
Removal of point-of-care fecal occult blood test from our ED was associated with a reduction in digital rectal examinations, particularly among chief complaints that may require fecal occult blood testing.
我们确定在急诊科（ED）中去除即时粪便潜血检测是否与记录的数字直肠检查减少有关。
我们进行了一项回顾性观察性图表审查研究，对所有因可能需要粪便潜血检测的主要投诉而到 ED 就诊的成年患者，在去除即时粪便潜血检测前后记录的数字直肠检查进行了研究。我们研究了在切换到即时粪便潜血检测和免疫组化实验室粪便潜血检测之间的 6 个月内的结果。我们将结果与同一时期就诊的具有主要投诉的类似患者队列进行了比较，这些投诉除了粪便潜血检测之外还有其他原因需要进行数字直肠检查（干预不敏感）。
在干预前后期间，共有 4981 名和 5557 名患者符合我们的纳入标准。我们观察到具有干预敏感主要投诉的患者的数字直肠检查总体减少了 10%（95%置信区间 [CI] 8%至 12%）。在主要投诉为腹痛、恶心/呕吐和腹泻的患者中，数字直肠检查的相对减少最大。在胃肠道出血、便秘和直肠问题较小的患者中观察到较小的减少。在干预不敏感的主要投诉中，记录的数字直肠检查总体减少了 3%（95%置信区间 [CI] 0%至 5%）。在控制所有协变量后，在干预后期间，干预敏感（比值比 0.44 [95%置信区间 0.39 至 0.50]）和在较小程度上干预不敏感（比值比 0.67 [95%置信区间 0.52 至 0.86]）的情况下，数字直肠检查减少。
从我们的 ED 中去除即时粪便潜血检测与数字直肠检查减少有关，特别是在可能需要粪便潜血检测的主要投诉中。
