1 Available online at www.medicinescience.org ORIGINAL RESEARCH Medicine Science 201.;.(.):… Retrospective investigation of the effectiveness of fecal occult blood test (FOB), PT- APTT in patients admitted to emergency department with gastrointestinal bleeding Ekim Saglam Gurmen 1 , Mucahit Avcil 2 , Bekir Dagli 2 , Kivanc Karaman 3 1 Ministry of Health, Salihli State Hospital, Manisa, Turkey 2 Adnan Menderes University Faculty of Medicine, Aydin, Turkey 3 Ministry of Health Sinop Atatürk State Hospital, Sinop, Turkey Received 21 May 2017; Accepted 16 June 2017 Available online 06.07.2017 with doi: 10.5455/medscience.2017.06.8660 Abstract The purpose of our study is to investigate the fact that gastrointestinal system bleeding, which is a major cause of mortality, is not diagnosed faster by any additional laboratory tests except physical examination and endoscopy, but it is negative in terms of time, workload and cost. Our study was retrospective and the hospital information system was scanned and the patients who were referred to Emergency Medicine Clinic between 01.08.2012-08.08.2013 with Gastrointestinal System (GIS) bleeding symptoms and then underwent endoscopic examination were investigated. Demographic characteristics, physical examination findings, vital signs, required examinations, digital rectal examination findings, endoscopy and colonoscopy results were recorded in the study form. For statistical analysis, SPSS (Statistical Package for Social Sciences) 17.0 program was used. A total of 274 patients aged 18 years and over were admitted to the study and 61.7% were male and 38.3% were female. Most of the patients in our diagnostic group were in the 70-79 age group. Sensitivity of Digital Rectal Examination (DRE) value was 79.6% Specificity 92.30%, negative predictive value (NPV) 60%, Sensitivity of Fecal Occult Blood Test (FOB) value was 31.46% NPV 30.49%, sensitivity of international normalized ratio (INR) was 26.25% NPV 32,95%, sensitivity of prothrombin time (PT) was 19.37%, NPV 34.84%, sensitivity of activated partial thromboplastin time (aPTT) was 14.19% NPV 34.43%. Endoscopies were performed in 169 patients with GIS bleeding and no active bleeding detected in 56 (33.1%) patients and in 113 (66.9%) patients active bleeding was detected. In patients with positive digital rectal examination findings, endoscopy results were also highly positive for gastrointestinal system bleeding. Our study suggests that; Running FOB, PT, APTT, INR tests in patients admitted to emergency department with GIS bleeding, is far from giving important and necessary information about the emergency management of the patients to emergency medicine specialists. The results of the digital rectal examination correlate with endoscopy results. It is also an easy and time-consuming examination method. From this point of view, we would like to emphasize that making the DRE of all patients with suspected GIS bleeding is a correct and immediate approach to the emergency physician. Keywords: GI bleeding, PT, APTT, INR, FOB, DRE, endoscopy, emergency medicine Introduction Upper gastrointestinal (GIS) hemorrhage is a gastric, duodenal ulcerous hemorrhage originating from the proximal of the trietz ligament. In patients presenting with oral blood, stool blood, or black stool coloration, upper GIS bleeding is an important cause of mortality and morbidity that should be excluded. Lower GIS bleeding is a bleeding originating from the distal part of the trietz ligament [1]. Like upper GIS hemorrhage, lower GIS hemorrhage is a life threatening common problem in emergency departments. Lower GIS hemorrhage is less common than upper GIS hemorrhage [2]. In this context; blood from upper GIS hemorrhage is the most common cause of blood detected in the lower GIS tract [3]. Upper GIS bleeding is always diagnosed by making esophagogastroduodenoscopy (EGD) [4-6]. In case of acute anemia or hemorrhagic shock, nasogastric tube administration before the EGD is helpful in the diagnostic approach [7]. Complete blood count, coagulation tests, blood group determination and serum biochemistry profile should be included among the initial laboratory evaluations after the peripheral large intravenous access. Physical examination findings may include orthostatic symptoms, postural changes, paleness, palpitation, fatigue, chest pain, dyspnea, tachypnea and abdominal pain. Anorectal digital examination (DRE) should be performed both to investigate whether there is anorectal disease and to confirm the stool color described by the patient. Colonoscopy should be performed as soon as possible in patients presenting with acute lower GIS bleeding [8]. Our primary goal in this study is to investigate incapability of laboratory tests such as fecal occult blood (FOB), prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR) to determine the presence of GIS bleeding and the extent of existence bleeding. Our secondary goal is to investigate the adverse effects of these blood Medicine Science International Medical Journal *Coresponding Author: Ekim Saglam Gurmen, Ministry of Health, Salihli State Hospital, Manisa, Turkey E-mail: ekimdr @hotmail.com