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

Date First Published:
February 21, 2017
Last Updated:
August 21, 2017
Report by:
Alvin Chin, Resident physician (McMaster University, Ontario, Canada)
Search checked by:
Kerstin De Wit, McMaster University, Ontario, Canada
Three-Part Question:
In [children with suspected intussusception] is a [negative fecal occult blood stool test sufficiently sensitive] to [rule out intussusception]?
Clinical Scenario:
It is Friday evening and a 2-year-old child presents to the ED with colicky abdominal pain. The ultrasound technician has left for the evening and no ultrasound imaging will be available over the weekend. You wonder whether you can 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)
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):
Study Title Patient Group Study type (level of evidence) Outcomes Key results Study Weaknesses
Intussusception: clinical presentations and imaging characteristics. Mandeville K , Chien M , Willyerd FA , et al . 2012 USA Patient aged 0-17 presenting to ED with diagnosis of intussusception Retrospective cohort study via chart review Negative fecal occult blood test 26% (25/98 patients with intussusception) #NAME?
The diagnosis of intussusception. Klein EJ , Kapoor D , Shugerman RP . 2004 USA Children seen in the children’s hospital ED in Washington with a suspicion of intussusception and underwent contrast enema Retrospective cohort study Negative fecal occult blood test 39% (7/18 patients with intussusception) - Small sample size
- Large number of cases missing guiac stool information
Ultrasonographic and clinical predictors of intussusception. Harrington L , Connolly B , Hu X , et al . 1998 Canada 3 months to 5 years of age and believed by ED attending to warrant air contrast enema to rule out intussusception Prospective descriptive cohort study Negative fecal occult blood test Negative 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
Stool appearance in intussusception: assessing the value of the term “currant jelly”. Yamamoto LG , Morita SY , Boychuk RB , et al 1997 107 inpatient children with intussusception Retrospective chart review Negative 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
Intussusception and the diagnostic value of testing stool for occult blood. Losek JD , Fiete RL 1991 USA Patients at Children’s hospital of Wisconsin with barium enema studies for evaluation of intussusception Retrospective chart review Negative fecal occult blood test 25% (4/16 of patients with intussusception) - Not all eligible patients had stool tested for blood
- Small sample size
Author Commentary:
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 prespecified number of patients due to lack of funding.
Bottom Line:
A negative fecal occult blood test cannot reliably rule out the diagnosis of intussusception.
References:
  1. Mandeville K , Chien M , Willyerd FA , et al .. Intussusception: clinical presentations and imaging characteristics.
  2. Klein EJ , Kapoor D , Shugerman RP . . The diagnosis of intussusception.
  3. Harrington L , Connolly B , Hu X , et al . . Ultrasonographic and clinical predictors of intussusception.
  4. Yamamoto LG , Morita SY , Boychuk RB , et al . Stool appearance in intussusception: assessing the value of the term “currant jelly”.
  5. Losek JD , Fiete RL. Intussusception and the diagnostic value of testing stool for occult blood.