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. 2024 Oct 6;16(10):e70922.
doi: 10.7759/cureus.70922. eCollection 2024 Oct.

Survey of Emergency Department Clinicians on the Utility of the Guaiac Fecal Occult Blood Test

Ehsan Shirazi  1 , Albertha V Lalljie  1 , Michael G Heckman  2 , Alexander Hochwald  3 , Osman Hamid  4 , Elmkdad Mohammed  1 , Johnathan M Sheele  1
Affiliations

Survey of Emergency Department Clinicians on the Utility of the Guaiac Fecal Occult Blood Test

Ehsan Shirazi et al. Cureus. .

Abstract

Introduction: 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.

Results: 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, 0.41/1x1012/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.

Conclusions: 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.

Keywords: acute gastrointestinal tract bleeding; guaiac fecal occult blood test; hematochezia; melena; undifferentiated anemia.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Mayo Clinic Institutional Review Board issued approval 10429. Mayo Clinic Institutional Review Board determined this study to be exempt from obtaining consent from patients due to its retrospective nature. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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