Does an Incidental Finding of a Positive FOBT in a Hospitalized Patient Warrant an In-patient Workup? A Pilot Study to Influence Length of Stay: 1417

Purpose: A positive fecal occult blood test (FOBT) is often the first and only indicator of colorectal disease. Current guidelines recommend additional evaluation in patients with a positive FOBT. These guidelines do not address whether patients with an incidental positive FOBT during an unrelated hospital stay require an in-patient workup. This workup usually lengthens the in-hospital stay by 1-2 days costing tens of millions of dollars in health care expenditure. The aim of our study is to assess the importance of endoscopic findings in hospitalized patients with an incidental positive FOBT. Methods: Charts of all patients with a positive FOBT from September 2007 to February 2009 at an urban teaching community hospital were reviewed. Patients who had GI complaints or had a history of GI disease were excluded. 84 patients met the criteria of an incidental positive FOBT. A single positive FOBT was considered adequate to qualify for inclusion. 41 of the 84 patients under went a GI workup as an in-patient (48%). Findings to be scored worthy of an in-patient investigation on EGD were gastric and duodenal ulcer, angiodysplasia, esophageal varices and cancer. Findings scored worthy of an in-patient investigation on colonoscopy were colitis, angiodysplasia and cancer. The t test was used to evaluate continuous variables, while the Chi-square test was used for categorical variables. Results: 41 out of 84 patients (48%) underwent endoscopic procedures. 35 of the 41 patients were African American (85%). 17 of this group showed findings scored worthy of an in-patient investigation (48%). 8 showed gastric and duodenal ulcers (22%), 4 showed angiodysplasias (11%) and 2 had carcinomas (5.7%). Male gender is associated with a positive finding, 78% male versus 16% female. However, there were significantly more females 32 (78%) compared to 9 (22%) of males in this cohort (P= 0.003). Conclusion: This pilot study suggests that in an urban community hospital with predominant African American demographics an incidental positive FOBT may warrant an in patient workup. Length of stay considerations should be weighed carefully against the possibility of losing follow up and thereby missing significant pathology.