Incidental findings on total-body CT scans in trauma patients
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.
References (23)
- et al.
Radiation exposure in whole-body computed tomography of multiple trauma patients: bearing devices and patient positioning
Injury
(2012) The incidentaloma: a medicolegal dilemma
Radiol Clin North Am
(2011)- et al.
Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center
J Emerg Med
(2010) - et al.
The prevalence and implications of incidental findings on ED abdominal CT scans
Am J Emerg Med
(2001) - et al.
Prevalence of incidental findings in trauma patients detected by computed tomography imaging
Am J Emerg Med
(2009) - et al.
Incidental radiographic findings after injury: dedicated attention results in improved capture, documentation, and management
Surgery.
(2010) - et al.
The prevalence of incidental findings on abdominal computed tomography scans of trauma patients
J Emerg Med
(2010) - et al.
Impact on patient care of discordance in radiology readings between external overnight radiology services and staff radiology readings at a level 1 Trauma Center
Am J Surg
(2013) - et al.
Effects on mortality, treatment, and time management as a result of routine use of total body computed tomography in blunt high-energy trauma patients
J Trauma Acute Care Surg
(2012) - et al.
Systematic review and meta-analysis of immediate total-body computed tomography compared with selective radiological imaging of injured patients
Br J Surg
(2012)
Systematic review and meta-analysis of routine total body CT compared with selective CT in trauma patients
Emerg Med J
Cited by (61)
Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis
2022, Annals of Emergency MedicineCatching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings
2022, Annals of Emergency MedicineCitation Excerpt :Our ED previously reported that incidental findings occurred in 32% of our trauma patients who underwent complete computed tomography (CT) trauma evaluations (ie, head, spine, chest, abdomen, and pelvis imaging), including 20% that were considered clinically significant.8 This prevalence is comparable to those in other trauma centers, which have reported incidental findings in 20% to 44% of patients undergoing complete CT evaluations.16-18 Studies have reported that less than 50% of incidental findings are communicated to patients, leading to patient safety and medicolegal concerns.11,18-20
Incidental Adrenal Masses: Adherence to Guidelines and Methods to Improve Initial Follow-Up, A Systematic Review
2022, Journal of Surgical ResearchAutomatic Detection of Thyroid and Adrenal Incidentals Using Radiology Reports and Deep Learning
2021, Journal of Surgical ResearchPrevalence of incidental findings on CT scans performed on trauma patients: What are we missing?
2021, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :One actionable improvement would entail a straightforward designation of who is responsible for communicating PCS findings to a patient. The number and variability of providers and specialists involved in trauma care make this a tricky question to answer, but solutions are within reach; for one, Sierink et al. report having implemented an electronic form that requires residents to inform patients of incidental findings [4]. Likewise, Wortman et al. reported increases in communication between ordering physicians and radiologists regarding their trauma patients’ symptoms after implementing a structured order entry system in the electronic medical record [20].