Inpatient, ED use of faecal immunochemical testing mostly incorrect: study

A recent study has discovered inappropriate use of faecal immunochemical testing (FIT) in emergency and inpatient settings. Moreover, FIT has led to more gastroenterology consultations but is not independently associated with inpatient endoscopy.

The authors reviewed all nonambulatory FITs conducted from November 2017 to October 2019 at a tertiary care community hospital using electronic medical records. They then obtained data on demographics, indications, gastroenterology consultations, and endoscopic procedures.

Finally, the authors determined the effect of FIT on gastroenterology consultation and endoscopy using multivariate logistic regression.

A total of 550 patients with at least one FIT test were identified; only three FITs (0.5 percent) had been carried out for colorectal cancer (CRC) screening. FITs were usually ordered from the emergency department (45.3 percent) or inpatient hospital floor (42.2 percent) for common indications such as anaemia (44.0 percent) and gastrointestinal bleeding (40.9 percent).

Of the patients, 253 (46.0 percent) tested positive; gastroenterology consultations were done for 120 (47.4 percent) patients compared with 43 of 297 (14.5 percent) of those who tested negative (odds ratio [OR], 3.28, 95 percent confidence interval [CI], 2.23‒4.82; p<0.0001).

A potential bleeding source was detected in 80 percent of patients with reported or witnessed overt gastrointestinal bleeding, similar to those who were FIT positive with overt gastrointestinal bleeding (80.7 percent; p=0.92).

In multivariate analysis, melena, hematemesis, and a positive FIT correlated with gastroenterology consultation (p<0.05 for all), but only melena (OR, 3.34, 95 percent CI, 1.48‒7.54) correlated with endoscopy.

“FIT is widely used for CRC screening, its only indication,” the authors noted.