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

Scales, Charles D. Jr MD* †; Fein, Steve MD*; Muir, Andrew J. MD*; Rockey, Don C. MD

Journal of Clinical Gastroenterology: November-December 2006 - Volume 40 - Issue 10 - p 913-918
doi: 10.1097/01.mcg.0000225674.14594.9f
Alimentary Tract: Clinical Research

Goals 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.

Background DRE at the time of hospital admission is frequently accompanied by FOBT. However, the utility of DRE with FOBT in this setting is unknown.

Study 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.

Results 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).

Conclusions 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.

*Division of Gastroenterology, Department of Medicine

Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC

Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX

Supported in part by a grant from the National Institutes of Health (T35-GM08679). Supported by the Burroughs Welcome Fund (D.C.R. is the recipient of a BWF Translational Scientist Award).

Reprints: Don C. Rockey, MD, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8887 (e-mail:

Received for publication January 9, 2006; accepted June 12, 2006

© 2006 Lippincott Williams & Wilkins, Inc.