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Ability of a fecal occult blood test in ruling out intussusception in children.

Three Part Question

Can a [negative fecal occult blood stool test] [rule out intussusception] in [pediatric patients]?

Clinical Scenario

It is Friday evening and a 2-year-old child presents with colicky abdominal pain to your emergency department. The ultrasound tech has left for the evening and no ultrasound imaging will be available over the weekend. Can you use a fecal occult blood test to rule out intussusception in this patient?

Search Strategy

Pubmed
((("occult blood"[MeSH Terms]) OR occult blood[Text Word]) OR occult bleeding[Text Word])) OR FOB[Text Word]) OR FOBT[Text Word])) AND (("intussusception"[MeSH Terms]) OR intussusception[Text Word])

Medline OVID interface
(intussusception.mp. or exp Intussusception/) AND (occult blood.mp. or exp Occult Blood/ or (FOBT or FOB).mp. or occult bleeding.mp)

Search Outcome

PubMed (Conception – Feb 20th, 2017
Medline OVID interface (1946 to February Week 2 2017)
36 articles found from PubMed and Medline – 12 unique and relevant from title or abstract analysis
5 reviews, 5 case studies, and 2 topic summaries
Review articles were analyzed.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Mandeville K, et al.
2012
USA
Patient aged 0-17 presenting to ED with diagnosis of intussusceptionRetrospective cohort study via chart reviewNegative fecal occult blood test26% (25/98 patients with intussusception)- Not all patients had documented guiaic or visual stool inspection for blood.
Klein E, et al.
2004
USA
Children seen in the children’s hospital ED in Washington with a suspicion of intussusception and underwent contrast enema Retrospective cohort studyNegative fecal occult blood test39% (7/18 patients with intussusception)- Small sample size - Large number of cases missing guiac stool information
Harrington L, et al.
1998
Canada
3 months to 5 years of age and believed by ED attending to warrant air contrast enema to rule out intussusceptionProspective descriptive cohort studyNegative fecal occult blood testNegative predictive value: 76%- Lack of funding resulted in only 88 out of 245 eligible children to be surveyed - The limited presentation of data makes it difficult to make more conclusions regarding the occult blood test
Yamamoto L, et al.
1997
107 inpatient children with intussusceptionRetrospective chart reviewNegative fecal occult blood test (if none in stool or no gross blood on rectal exam)59% (16/27 patients with intussusception) - Not all patients received a fecal occult blood test – patients with obvious blood were excluded (explicitly) thereby changing the proportion of patients who would have had a negative result if all were included
Losek J and Fiete R.
1991
USA
Patients at Children’s hospital of Wisconsin with barium enema studies for evaluation of intussusceptionRetrospective chart reviewNegative fecal occult blood test25% (4/16 of patients with intussusception)- Not all eligible patients had stool tested for blood - Small sample size

Comment(s)

All studies had fewer than 100 patients and only one of the studies directly looked at the utility of a fecal occult blood test in a prospective design on all enrolled patients in the study. However that prospective study was stopped prior to enrolling the pre-specified number of patients due to lack of funding.

Editor Comment

KMJ keeper

Clinical Bottom Line

While there are only a handful of relevant studies that included the use of a fecal occult blood test in the diagnosis of intussusception, the data suggests that a significant percentage of patients with intussusception can have a negative fecal occult blood test. Therefore a negative fecal occult blood test cannot reliably rule out the diagnosis of intussusception.

References

  1. Mandeville, K., Chien, M., Willyerd, F. A.et al. Intussusception: clinical presentations and imaging characteristics. Pediatric Emergency Care 2012;28(9), 842-844.
  2. Klein, E. J., Kapoor, D., & Shugerman, R. P. The diagnosis of intussusception. Clinical pediatrics, 2004; 43(4), 343-347.
  3. Harrington, L., Connolly, B., Hu, X.et al. Ultrasonographic and clinical predictors of intussusception. The Journal of pediatrics, 1998: 132(5), 836-839.
  4. Yamamoto, L. G., Morita, S. Y., Boychuk, R. B et al. Stool appearance in intussusception: assessing the value of the term “currant jelly”. The American journal of emergency medicine, 1997, 15(3), 293-298.
  5. Losek, J. D., & Fiete, R. L. Intussusception and the diagnostic value of testing stool for occult blood. The American journal of emergency medicine, 1991, 9(1), 1-3.