title: Inappropriate use of the faecal occult blood test in a university hospital in the Netherlands.
abstract: OBJECTIVE
  Although all international guidelines state that there is no indication to perform a faecal occult blood test (FOBT) in symptomatic patients, we believe the test is frequently used as a diagnostic test. The objective of this study was to investigate whether the current guidelines for FOBT use are being followed in the Netherlands.
  
  
  METHODS
  The frequency of reasons for ordering a FOBT in 15 hospitals over a time period of 1 year was determined and the consequences of the test result on the diagnostic workup were determined by a retrospective search of electronic hospital charts.
  
  
  RESULTS
  In 14 of the 15 hospitals a FOBT was available and totally 2993 FOBTs were performed in 1 year. A total of 201 electronic charts were retrieved. The FOBTs were ordered because of anaemia (41%), suspicion of rectal bleeding (17%), abdominal pain (14%), changed bowel habits (10%) or others (18%). A positive test result was found in 66 (33%) patients and a negative in 133 (66%). Respectively, 38% (25/66) of the patients with a positive and 41% (55/133) of the patients with a negative test result received a gastrointestinal follow-up investigation. In 25/80 investigations, a possible cause of rectal blood loss was detected, of which 13 had a positive FOBT result.
  
  
  CONCLUSIONS
  This study demonstrates that current guidelines on FOBT use are not followed in the Netherlands and that a FOBT is often used as a diagnostic tool instead of a screening tool, thereby causing confusion and unnecessary delays in the diagnostic workup of patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands. a.f.vanrijn@amc.nl
authors.forename: Anne F
authors.initials: AF
authors.lastname: van Rijn
authors.forename: An K
authors.initials: AK
authors.lastname: Stroobants
authors.forename: Marije
authors.initials: M
authors.lastname: Deutekom
authors.forename: Corinne
authors.initials: C
authors.lastname: Lauppe
authors.forename: Auguste
authors.initials: A
authors.lastname: Sturk
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D005260:Female; D019983:Guideline Adherence; D006403:Hematologic Tests / Q000592:standards / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009426:Netherlands; D009780:Occult Blood; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D019564:Unnecessary Procedures / Q000592:standards / Q000706:statistics & numerical data*; D014600:Utilization Review; D055815:Young Adult