Background: Given its ability to identify obscure bleeding at a rate of 0.1-0.5 mL/min, technetium-labeled red cell scans have long been considered the most sensitive radiographic test for gastrointestinal bleeding. They are routinely compared to computed tomography angiography, which detects bleeding at a minimum rate of 0.5 mL/min or greater. We conducted a clinical quality improvement study to determine the diagnostic yield of performing technetium-labeled RBC scans.
Methods: A cross sectional design was used with the starting population being individuals admitted under the non-specific lower gastrointestinal bleed ICD10 Code between the years of 2015-2019 at an academic medical center who received a Technetium-Labeled Red Cell Scan. We analyzed these individuals to determine the number of scans performed before a positive was obtained. The individuals in whom a positive scan was obtained were further explored to determine whether a procedural intervention was performed. Going even further with our analysis, the patients whom had an intervention performed were evaluated for interventions that resulted in a change to their clinic outcome. A cost analysis was then performed.
Results: Out of 200 scans, there was n = 40 (20%) positive. Of those, n = 25 (62.5% of positive scans) led to an intervention. Out of those n = 25 positive scans that led to an intervention, n = 13 (52%) led to a change in outcome. The institutions average cost of a 99mtechnetium-labeled red cell scan at approximately $1894.5. With the cost analysis, we are spending $28,628.50 until an intervention that lead to a change in outcome was performed on a positive scan.
Conclusions: Following the analysis of the 200 patients admitted with a non-specific lower GI bleed, only 13% of these scans are resulting in a direct change in our patient’s clinic outcome. In addition, we are spending $28,628.5 until a positive scan is obtained and yielding a change in our patient’s clinical outcome. This clinic quality improvement study strongly suggests that there are multiple factors that should be taken into consideration when decisions are made about which diagnostic test should be performed to better characterize non-specific lower GI bleeding. Determining whether the goal of the tests we are ordering is to be diagnostic, therapeutic or both is key. We should continue to consider patient specific factors including: hemodynamic stability, volume of bleed, hemoglobin/hematocrit and co-morbidities when determining which mode of imaging is more appropriate.