Prospective evaluation of the use and outcome of admission stool guaiac testing: the Digital Rectal Examination on Admission to the Medical Service (DREAMS) Study.
BACKGROUND
Although physicians often perform fecal occult blood testing at the time of hospital admission, the practice of admission stool guaiac (ASG) testing has not been evaluated prospectively. The aim of this study was to determine the frequency and outcomes of digital rectal examination (DRE) and ASG testing in patients admitted to the hospital.


METHODS
We prospectively evaluated 2143 patients admitted to the medical service at our hospital over a 1-year period. A detailed clinical history was obtained, and the proportion of patients who had DRE and ASG testing, the frequency of positive tests, and the results of follow-up testing were determined.


RESULTS
A DRE was performed in 1539 of the 2143 subjects (71.8%), and 1.8% had abnormal findings, 21.8% had a normal examination, and the result of ASG testing was the only documented finding in the remaining 76.4% of patients. ASG testing was performed in 1342 of the 2143 subjects (62.6%), and the ASG test was positive in 237 persons (17.7%). However, only 161 (67.9%) of those with a positive ASG test had further diagnostic testing and a colonic source of occult gastrointestinal blood loss was detected in 68 (42.2%) of these 161 persons.


CONCLUSIONS
Although DRE and ASG testing are commonly performed on admission to the hospital, documentation of the findings and follow-up of positive tests are poor. These findings highlight the need to improve physician training on the appropriate use and documentation of the DRE and fecal occult blood testing.
Bini
Edmund J
EJ
Department of Medicine, VA New York Harbor Healthcare System, New York, NY 10010, USA. Edmund.Bini@med.va.gov
Reinhold
Jean-Pierre
JP
Weinshel
Elizabeth H
EH
Generoso
Ramon
R
Salman
Loay
L
Dahr
Georges
G
Pena-Sing
Ivan
I
D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D051517:Digital Rectal Examination / Q000706:statistics & numerical data*; D005260:Female; D006138:Guaiac; D006801:Humans; D007202:Indicators and Reagents; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010343:Patient Admission; D011446:Prospective Studies
D007202:Indicators and Reagents; D006138:Guaiac