Eliminating the Test
In response, several hospitals have specifically removed the test either from use in the emergency department or the entire hospital.9,10 Parkland Hospital in Dallas, for example, retrospectively evaluated their practice patterns and identified FOBT as a low-value intervention used outside its appropriate scope. After a marginally successful initial attempt at reducing its use through educational interventions, the hospital simply eliminated the test. The discontinuation was led by the gastroenterology group, justifying their de-adoption by focused dissemination of cases in which the FOBT result had misled physicians. For example, there had been a colonic neoplasm thought to have been missed due to a false-negative FOBT collected by digital rectal examination. In many cases, unnecessary upper endoscopies were performed in response to false-positive results.
Explore This IssueACEP Now: Vol 38 – No 08 – August 2019
While a simple, sensitive, and specific test for upper gastrointestinal bleeding would certainly be of value, for want of such test, we should not mischaracterize and rely upon a poor one. It is absolutely time to retire—as my institution has—the guaiac-based FOBT from emergency department and inpatient use.
The opinions expressed herein are solely those of Dr. Radecki and do not necessarily reflect those of his employer or academic affiliates.
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