Elsevier

Injury

Volume 45, Issue 5, May 2014, Pages 840-844
Injury

Incidental findings on total-body CT scans in trauma patients

https://doi.org/10.1016/j.injury.2013.10.009Get rights and content

Abstract

Introduction

Total-body Computed Tomography (CT) scans are increasingly used in trauma care. Herewith the observation of incidental findings, trauma unrelated findings, is also increased. The aim of this study was to evaluate the number of incidental findings in adult trauma patients.

Patients and methods

All consecutive trauma patients that underwent total-body CT scanning between January 2009 and December 2011 were analysed. Incidental findings were divided in three categories: category I (potentially severe condition, further diagnostic work-up is required), category II (diagnostic work-up dependent on patients’ symptoms) and category III (findings of minor concern, no diagnostic work-up required).

Results

There were 2248 trauma room presentations; 321 patients underwent a total-body CT scan (14.3%). In 143 patients (44.5%), 186 incidental findings were reported. There were 13 category I findings (7.0%), 45 category II findings (24.2%) and 128 category III incidental findings (68.8%). Overall, 18 patients (5.6%) required additional diagnostic work-up. Four patients underwent work-up by additional radiologic imaging. Three patients required further invasive work-up or treatment. Three patients were transferred to another hospital, no extended follow-up was performed. In three patients, there was no documentation of follow-up. Five patients deceased before diagnostic work-up of the incidental finding could start.

Conclusion

Total-body CT scanning as part of the evaluation of trauma patients leads to a substantial amount of incidental findings. Documentation of incidental findings and their clinical consequences was incomplete. Therefore, the findings of this study have prompted us to add an item to our electronic trauma room report that obliges residents to report whether or not incidental findings are found during trauma imaging.

Introduction

Total-body Computed Tomography (CT) scanning is increasingly used as a diagnostic technique in trauma patients. The main advantage of this total-body imaging concept is a quick and complete overview of traumatic injuries in all relevant body regions (head to pelvis) [1], [2], [3]. One of the most important disadvantages is the associated radiation exposure [4], [5]. Another point of interest is the observation of incidental findings on total-body CT scanning. These are defined as findings that are totally unrelated to the clinician's reasons for requesting the radiological examination [6]. These incidental findings might be beneficial to patients in case of earlier detection of a malignancy. Conversely, it might result in increased patients’ anxiety and health care costs in case of additional work-up for abnormalities that ultimately might not affect patients’ health [7], [8].

The total amount of incidental findings on selective CT scans of one or more body regions in trauma patients varies between 34% [9] and 45% [10], [11]. A recent study reported a 36% incidental findings rate on routine thoracoabdominal CT in trauma patients [14]. Only two studies evaluated incidental findings in patients that underwent a total-body CT scan as part of the initial trauma evaluation and incidental finding numbers of 50% and 53% were found [15], [16]. However, indications for a total-body CT scan were not described in both studies and the clinical consequences of these incidental findings were unclear [15].

Therefore, the aim of this study was to evaluate the percentage of incidental findings and their clinical consequences in a cohort of adult trauma patients who underwent total-body CT scanning.

Section snippets

Patient selection

All consecutive trauma patients admitted to our academic Level I trauma centre that underwent total-body CT scanning between January 2009 and December 2011 were included in this study. All patients fulfilling the in- and exclusion criteria listed in Table 1 underwent immediate total-body CT scanning. Prior conventional imaging was not an exclusion criterion for the present study.

Total-body CT

All patients were evaluated on a sliding gantry 64-slice CT-scanner (Sensation 64, Siemens Medical Solutions,

Results

There were 2248 trauma room presentations between 2009 and 2011 of which 321 patients underwent a total-body CT scan (14%) during trauma survey. Patient characteristics of the study population are shown in Table 2. In 143 patients (45%), 186 incidental findings were found. Incidental findings per body region according to category are depicted in Fig. 1. Most incidental findings were located in the abdomen.

Table 3 shows the incidental findings of category I (potentially severe condition, further

Discussion

This study shows that the percentage of incidental findings in a cohort of adult trauma patients that underwent total-body CT scanning is 45%. Most incidental findings were located in the abdomen. Overall, 18 patients (6%) received complementary diagnostic work-up or therapeutic intervention because of a potentially severe condition. In three patients, there was no documentation of follow-up found in the medical chart despite recommendation for follow-up of their category I incidental finding.

Conclusion

Total-body CT scanning as part of the evaluation of trauma patients leads to a substantial amount of incidental findings. The majority of findings does not require further diagnostic work-up or therapeutic intervention although some life-threatening findings were detected.

Documentation of incidental findings and their clinical consequences was incomplete. Therefore, the findings of this study have prompted us to add an item to our electronic trauma room report that obliges residents to report

Conflict of interest statement

All authors participated actively in the study and approved the manuscript in its present form. All authors declare that there is no financial support or relationship that may pose conflict of interest. The manuscript is not under consideration for publication elsewhere.

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