Can J Gastroenterol Hepatol. 2014 Sep;28(8):421-6. doi: 10.1155/2014/189652. Epub 2014 Jul 11.
The fecal occult blood test (FOBT) is a screening tool designed for the early detection of colorectal cancer in primary care. Although not validated for use in hospitalized patients, it is often used by hospital physicians for reasons other than asymptomatic screening.
To profile the in-hospital use of the FOBT and assess its impact on patient care.
Patient charts were retrospectively reviewed for all FOBTs conducted over a three-month period in 2011 by the central laboratory supporting the three acute care campuses of Hamilton Health Sciences (Hamilton, Ontario).
A total of 229 patients underwent 351 tests; 52% were female and the mean age was 49 years (range one to 104 years). A total of 80 (34.9%) patients had at least one positive test. The most common indications for testing were anemia (51.0%) and overt gastrointestinal bleeding (19.2%). Only one patient had testing performed for asymptomatic colorectal cancer screening. In only 20 (8.7%) cases medications were modified before testing and diet was modified in only 21 (9.2%) cases. Most patients (85.2%) were taking one or more medications that could result in a false-positive result. Only 18 (7.9%) patients had a digital rectal examinations documented, of which seven were positive. All patients with a positive digital rectal examination underwent endoscopic procedures that revealed a source of bleeding. Among 44 patients with overt gastrointestinal bleeding, 12 (27.3%) had endoscopic investigations delayed to await results of the FOBT. Four patients were referred despite a negative FOBT due to a high degree of suspicion of gastrointestinal bleeding.
The FOBT is often used inappropriately in the hospital setting. Confounding factors, such as diet and medication use, which may lead to false positives, are often ignored. Use of the FOBT in-hospital may lead to inappropriate management of patients, increased length of stay and increased direct medical costs. Use of the FOBT should be limited to validated indications only.
粪便潜血试验（FOBT）是一种用于初级保健中早期发现结直肠癌的筛查工具。尽管尚未经过验证可用于住院患者，但医院医生出于无症状筛查以外的原因经常使用它。
分析住院患者使用 FOBT 的情况，并评估其对患者治疗的影响。
对 2011 年三个月期间由支持汉密尔顿健康科学（安大略省汉密尔顿）三个急症护理校区的中心实验室进行的所有 FOBT 进行了回顾性病历审查。
共有 229 名患者进行了 351 次检测；女性占 52%，平均年龄为 49 岁（1-104 岁）。共有 80 名（34.9%）患者的检测结果呈阳性。检测最常见的指征是贫血（51.0%）和显性胃肠道出血（19.2%）。仅有 1 名患者进行了无症状结直肠癌筛查的检测。在检测前仅对 20 名（8.7%）患者调整了药物，仅对 21 名（9.2%）患者调整了饮食。大多数患者（85.2%）正在服用一种或多种可能导致假阳性结果的药物。仅 18 名（7.9%）患者的直肠指检记录在案，其中 7 名呈阳性。所有直肠指检阳性的患者均进行了内镜检查，发现了出血来源。在 44 名显性胃肠道出血患者中，有 12 名（27.3%）患者的内镜检查因等待 FOBT 结果而延迟。由于高度怀疑胃肠道出血，尽管 FOBT 结果为阴性，仍有 4 名患者被转介。
FOBT 在医院环境中经常被不恰当地使用。常被忽视的混杂因素，如饮食和药物使用，可能导致假阳性。医院内使用 FOBT 可能导致患者的治疗管理不当、住院时间延长和直接医疗费用增加。FOBT 的使用应仅限于经过验证的适应证。
