Shirazi Ehsan, Lalljie Albertha V, Heckman Michael G, Hochwald Alexander, Hamid Osman, Mohammed Elmkdad, Sheele Johnathan M
Emergency Medicine, Mayo Clinic, Jacksonville, USA.
Biostatistics, Mayo Clinic, Jacksonville, USA.
Cureus. 2024 Oct 6;16(10):e70922. doi: 10.7759/cureus.70922. eCollection 2024 Oct.
Emergency department (ED) clinicians utilize the guaiac fecal occult blood test (gFOBT) in their assessment of suspected gastrointestinal bleeding or unexplained anemia despite supporting evidence. ED clinicians' ability to predict the gFOBT results and how the gFOBT results could affect ED patient disposition has not been previously studied. Methods: From October 16, 2019, through September 15, 2020, we conducted a single-site survey of ED clinicians before and after performing gFOBTs during routine clinical care. Survey data were collected and retrospectively evaluated with unadjusted and multivariable regression analyses.
We examined a total of 133 combined pre-gFOBT and post-gFOBT surveys. ED clinicians accurately predicted gFOBT results with an area under the receiver operating characteristic curve of 0.75 (95%CI, 0.66-0.85). Of clinician-predicted certain or very probable positive gFOBT results, only 79% were actually positive. In multivariable analyses, decreased hematocrit level (odds ratio (OR), 0.31/10% increase; 95%CI, 0.14-0.61), decreased red blood cell count (OR, 0.41/1x10/L increase; 95%CI, 0.21-0.75), and absence of firm stool consistency (OR, 0.09; 95%CI, 0.01-0.42) were associated with positive gFOBT results (all P<.006). The most common reason for performing gFOBTs was black stool or suspected melena, followed by decreased hemoglobin level, red blood in stool, and suspected upper gastrointestinal tract bleeding. Before performing gFOBT, 50.8% of clinicians responded that the test results would change patient disposition, which decreased to 30.5% after the gFOBT result.
We found that ED clinicians cannot predict the gFOBT results with high accuracy. A suspected GI bleed is the main reason for performing the test in the ED.
急诊科（ED）临床医生在评估疑似胃肠道出血或不明原因贫血时会使用愈创木脂粪便潜血试验（gFOBT），尽管缺乏支持证据。此前尚未研究过急诊科临床医生预测gFOBT结果的能力以及gFOBT结果如何影响急诊科患者的处置。方法：从2019年10月16日至2020年9月15日，我们在常规临床护理中对进行gFOBT前后的急诊科临床医生进行了单中心调查。收集调查数据并通过未调整和多变量回归分析进行回顾性评估。
我们共检查了133份gFOBT前和gFOBT后的联合调查问卷。急诊科临床医生预测gFOBT结果的准确性较高，受试者工作特征曲线下面积为0.75（95%CI，0.66 - 0.85）。在临床医生预测为肯定或很可能为阳性的gFOBT结果中，实际仅79%为阳性。在多变量分析中，血细胞比容水平降低（比值比（OR），每增加10%为0.31；95%CI，0.14 - 0.61）、红细胞计数降低（OR，每增加1×10¹²/L为0.41；95%CI，0.21 - 0.75）以及大便质地不硬（OR，0.09；95%CI，0.01 - 0.42）与gFOBT结果为阳性相关（所有P <.006）。进行gFOBT最常见的原因是黑便或疑似柏油样便，其次是血红蛋白水平降低、大便带血以及疑似上消化道出血。在进行gFOBT之前，50.8%的临床医生表示检测结果会改变患者的处置，而在gFOBT结果出来后这一比例降至30.5%。
我们发现急诊科临床医生不能高精度地预测gFOBT结果。疑似胃肠道出血是在急诊科进行该项检测的主要原因。
