Abstract
Utilization of Fecal Immunochemical Test in a Tertiary Government Hospital: A Retrospective Cohort Study
Bea Regine Panganiban, MD; Jayson Villavicencio, MD; Eric Yasay, MD
University of the Philippines – Philippine General Hospital
Significance: The only validated indication for fecal immunochemical test (FIT) is colorectal cancer (CRC) screening. No local studies have explored FIT practice trends. We examined FIT utilization, focusing on its indications and impact on clinical management and outcomes.
Methodology: This retrospective cohort study involved chart reviews of adult patients who underwent FIT from January 1 to December 31, 2023. Logistic regression analysis was used to determine the association of FIT positivity with gastroenterology referrals, endoscopic procedures, and findings.
Results: A total of 701 patients were analyzed, with 516 (73.6%) from outpatient clinics and 317 (60.47%) for CRC screening. Inappropriate FIT requests were common, with 204/516 (39%) outpatient and 180/185 (97%) inpatient tests ordered outside evidence-based indications; outpatient tests had a significantly lower rate of inappropriate requests (Z-score-4.39,p<0.05). Among inpatients, 162/185 (87.57%) were for anemia, while only 5 (2.7%) were for CRC screening. Of the positive FITs for anemia, only 10/237 patients (4.22%) had a potential gastrointestinal cause identified. Notably, 63% (85/136) of FIT-positive inpatients were not referred to gastroenterology. None underwent annual serial FIT after a negative result. While FIT positivity correlated with increased gastroenterology referrals (OR 13.84, 95%CI 8.92,21.48, p<0.001) and subsequent endoscopy (OR 6.60, 95%CI 4.09,10.66, p<0.001) in outpatients, it did not significantly relate to inpatient endoscopy. Importantly, majority of inpatients who underwent FIT were critically ill.
Conclusion: FIT was often ordered in clinically inappropriate settings and did not consistently translate to effective clinical management or follow-up endoscopy particularly among inpatients, confirming limited clinical utility in this setting.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |