Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis.
Division of Biostatistics & Health Data Science, Indiana University-Purdue University, Indianapolis.
Am J Med. 2022 Jan;135(1):76-81. doi: 10.1016/j.amjmed.2021.08.004. Epub 2021 Sep 9.
Fecal immunochemical testing (FIT) is widely used for colorectal cancer screening, its only indication. Its effect on clinical decision-making beyond screening is unknown. We studied the use of FIT in emergency and inpatient settings and its impact on patient care.
Using electronic medical records, we reviewed all non-ambulatory FITs performed from November 2017 to October 2019 at a tertiary care community hospital. We collected data on demographics, indications, gastroenterology consultations, and endoscopic procedures. Multivariate logistic regression was performed to determine the effect of FIT on gastroenterology consultation and endoscopy.
We identified 550 patients with at least 1 FIT test. Only 3 FITs (0.5%) were performed for colorectal cancer screening. FITs were primarily ordered from the emergency department (45.3%) or inpatient hospital floor (42.2%). Anemia (44.0%), followed by gastrointestinal bleeding (40.9%), were the most common indications. FIT was positive in 253 patients (46.0%), and gastroenterology consultation was obtained for 47.4% (n = 120), compared with 14.5% (n = 43) of the 297 FIT-negative patients (odds ratio 3.28; 95% confidence interval, 2.23-4.82, P < .0001). A potential bleeding source was identified in 80% of patients with reported or witnessed overt gastrointestinal bleeding, a similar proportion (80.7%; P = .92) to patients who were FIT positive with overt gastrointestinal bleeding. Multivariate analysis showed that melena, hematemesis, and a positive FIT were associated with gastroenterology consultation (all P < .05), while only melena (odds ratio 3.34; 95% confidence interval, 1.48-7.54) was associated with endoscopy.
Nearly all emergency department and inpatient FIT use was inappropriate. FIT resulted in more gastroenterology consultation but was not independently associated with inpatient endoscopy.
粪便免疫化学检测（FIT）广泛用于结直肠癌筛查，这是其唯一的适应证。但其在筛查之外对临床决策的影响尚不清楚。我们研究了 FIT 在急症和住院环境中的应用及其对患者治疗的影响。
使用电子病历，我们回顾了 2017 年 11 月至 2019 年 10 月在一家三级社区医院进行的所有非活动性 FIT 检测。我们收集了人口统计学、适应证、胃肠病学咨询和内镜检查的数据。采用多变量逻辑回归分析 FIT 对胃肠病学咨询和内镜检查的影响。
我们确定了 550 例至少进行了 1 次 FIT 检测的患者。只有 3 次 FIT（0.5%）用于结直肠癌筛查。FIT 主要由急诊科（45.3%）或住院病房（42.2%）开具。贫血（44.0%），其次是胃肠道出血（40.9%），是最常见的适应证。253 例患者的 FIT 检测结果为阳性（46.0%），其中 47.4%（n=120）获得了胃肠病学咨询，而 297 例 FIT 检测阴性患者中仅有 14.5%（n=43）获得了咨询（比值比 3.28；95%置信区间，2.23-4.82，P<.0001）。有显性胃肠道出血症状或有显性胃肠道出血报告的患者中，80%的患者发现了潜在的出血源，这一比例与有显性胃肠道出血且 FIT 阳性的患者相似（80.7%；P=0.92）。多变量分析显示，黑便、呕血和 FIT 阳性与胃肠病学咨询相关（均 P<.05），而只有黑便（比值比 3.34；95%置信区间，1.48-7.54）与内镜检查相关。
几乎所有急诊科和住院部的 FIT 检测应用都是不恰当的。FIT 检测增加了胃肠病学咨询，但与住院部内镜检查无独立相关性。
