# Faecal occult blood testing in persons aged 50–74 years with established spinal cord injury: a prospective case series

## TL;DR

People with spinal cord injuries have higher false positive fecal occult blood test results due to bowel complications, making FOBT less reliable for them.

## Contribution

This study is the first to investigate FOBT accuracy in spinal cord injury patients, revealing high false positives linked to bowel management practices.

## Key findings

- 50% of spinal cord injury patients tested positive on FOBT.
- 90% of those using rectal enemas or manual evacuation had positive FOBT results.
- Colonoscopy follow-up rates were low due to concerns about bowel preparation.

## Abstract

Prospective Case Series.

To determine the incidence of positive faecal occult blood test (FOBT) in people with spinal cord injury (SCI). We hypothesised that people with SCI have a higher false positive FOBT rate when compared to the general population due to the high prevalence of complications of chronic constipation, and colonic and anorectal trauma from instrumentation.

Hospital in Sydney, New South Wales, Australia.

A prospective study was conducted at a quaternary hospital with a dedicated spinal injuries unit. Enrolled individuals had two FOBT samples sent. Persons outside the age criteria, or with active per-rectal or vaginal bleeding, anorectal disease, haematuria, recent SCI or colonoscopy, or who had completed FOBT as part of the National Bowel Cancer Screening Program were excluded.

A total of 20 people were included in the study with 50% testing positive on FOBT. Three persons agreed to proceed with colonoscopy. All persons who declined colonoscopy were due to perceived difficulty with procedure preparation. FOBTs were positive in 90% of those who reported rectal enema, digital simulation or manual evacuation as part of their bowel care.

People with SCI have higher rates of positive FOBT compared to the general Australian population whilst follow-up colonoscopy rates were low. Compliance may be improved by bowel preparation protocols. High rates of positive FOBT in this population may be related to complications of constipation and bowel care. Our results suggest that FOBT is not an accurate screening tool in this population.