Clinical Utilization of Digital Rectal Examination and Fecal Occult Blood Testing Upon Hospital Admission

Abstract

The objective of our investigation was to examine the clinical utilization of digital rectal examination (DRE) and fecal occult blood testing (FOBT) at hospital admission. DRE at the time of hospital admission is frequently accompanied by FOBT. However, the utility of DRE with FOBT in this setting is unknown. The study cohort comprised consecutive admissions to an internal medicine service over a 3-month period. Patient characteristics were compared for subjects by DRE performance and FOBT result. Follow-up endoscopic procedures within 1 year of admission were recorded. Complete data were available for 806 of 832 patients (96.9%). Three hundred forty eight patients underwent DRE on admission (43.2%). Patients undergoing DRE/FOBT were older (mean age 60.4+/-18.4 y vs. 55.0+/-19.6 y, P<0.001). Patients with gastrointestinal (GI) bleeding symptoms (relative risk 11.2, 95% confidence interval 5.47-23.0) or a past history of GI bleeding (relative risk 2.98, 95% confidence interval 1.93-4.58) were more likely to undergo DRE/FOBT. Among 130 (37.4%) patients with a positive FOBT, 72 (51.6%) had no history of GI bleeding symptoms; these patients were substantially less likely to undergo follow-up examination(s) than patients with a positive FOBT and a history of GI bleeding symptoms (30.6% vs. 82.8%, P<0.001). In this cohort, patients with a past history of GI disease or symptoms were more likely to undergo FOBT. Follow-up evaluation of positive FOBT in the absence of GI bleeding symptoms was very low. Low utilization and follow-up rates may limit the utility of admission DRE with FOBT for cancer screening.