A62 THE UTILITY OF FECAL IMMUNOCHEMICAL TEST IN HOSPITALIZED PATIENTS: A RETROSPECTIVE CHART REVIEW
Bibliographic record
Abstract
Abstract Background Fecal immunochemical test (FIT) is a colorectal cancer (CRC) screening tool that uses antibodies to detect the globin moiety of human hemoglobin. On average, one test costs approximately $35 CAD. It has been widely validated as an effective screening tool that is both more sensitive than fecal occult blood testing, and less likely to react to non-human sources of blood, such as from dietary sources. Despite an absence of evidence for use in hospitalized patients, it is commonly ordered in this setting. Aims To assess the value and appropriateness of FIT in hospitalized patients in an urban health authority. Methods All FITs ordered for hospitalized patients between August 1, 2017 and June 1, 2018 in one academic hospital in Regina, Saskatchewan were examined. Of the 626 cases that were identified, information regarding demographics, clinical presentation, consultations, laboratory values, and endoscopy results were recorded. Results Of all 626 FITs ordered, 204 were positive and 422 were negative. Hospitalist physicians ordered 41% of these FITs. Of the 197 patients with negative FITs whose clinical data were available, 39% proceeded to gastroscopy and 23% proceeded to colonoscopy/flexible sigmoidoscopy during admission. Of the 201with positive FITs whose clinical data were available, 58% proceeded to gastroscopy and 40% proceeded to colonoscopy/flexible sigmoidoscopy during admission. FIT had a sensitivity of 100% (95% CI: 94–100%) and specificity of 3% (95% CI: 0–15%) to detect abnormal colonoscopy/flexible sigmoidoscopy results while having a sensitivity of 67% (95% CI: 57–78%) and specificity of 45% (95% CI:36–55%) to detect abnormal gastroscopy. Using a composite of uninvestigated iron deficiency, age >75 or <50 years, clinically overt bleeding, endoscopy despite negative FIT, and up-to-date CRC screening as a definition for inappropriate use of FIT, we found that 7% of negative FITsand 4% of positive FITs were appropriately ordered. Conclusions FIT tests had excellent sensitivity for lower gastrointestinal bleeding but had a high false positive rate in this population. FIT tests performed poorly in upper gastrointestinal bleeding. Using FIT for its validated purpose of CRC screening was done in a minority of cases. Importantly, 60% of patients with negative FIT tests proceeded to endoscopy, which may suggest that FITs in hospitalized patients does not significantly alter clinical decision making in a majority of cases. Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".