Prevalence and clinical significance of incidental findings in chest and abdominopelvic CT scans of trauma patients; A cross-sectional study.

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  • Additional Information
    • Source:
      Publisher: W B Saunders Country of Publication: United States NLM ID: 8309942 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8171 (Electronic) Linking ISSN: 07356757 NLM ISO Abbreviation: Am J Emerg Med Subsets: MEDLINE
    • Publication Information:
      Publication: 1983- : Philadelphia, PA : W B Saunders
      Original Publication: [Philadelphia, PA. : Centrum Philadelphia, c1983]-
    • Subject Terms:
      Incidental Findings* ; Tomography, X-Ray Computed*/statistics & numerical data; Humans ; Female ; Male ; Middle Aged ; Cross-Sectional Studies ; Adult ; Prevalence ; Emergency Service, Hospital/statistics & numerical data ; Trauma Centers/statistics & numerical data ; Pelvis/diagnostic imaging ; Pelvis/injuries ; Radiography, Thoracic/statistics & numerical data ; Radiography, Abdominal/statistics & numerical data ; Wounds and Injuries/diagnostic imaging ; Wounds and Injuries/epidemiology ; Clinical Relevance
    • Abstract:
      Background: Imaging may inadvertently reveal pathologies unrelated to their performing purpose, known as incidental findings (IF). This study aimed to assess the prevalence, clinical significance, and documentation of IFs in chest and abdominopelvic computed tomography (CT) scans of trauma patients.
      Methods: This observational study was conducted at two urban level-1 trauma centers from March 2019 through April 2022. Official radiology reports of trauma patients who underwent chest and/or abdominopelvic CT scans at the emergency department (ED) were explored, and IF were extracted. Predictive factors of the presence of IFs and their documenting were investigated.
      Results: Out of 656 chest and 658 abdominopelvic CT scans, 167 (25.37%) and 212 (32.31%) scans harbored at least one IF, respectively. Patients with IFs tended to be of higher age and female in both chest (age: 48 [IQR: 35-62] vs. 34 [IQR: 25-42.5]; female: 31.14% vs 14.66%, p < 0.001 for both) and abdominopelvic CT scans (age: 41 [IQR: 30-57.5] vs 33 [IQR: 25-43], female: 26.42% vs. 13.96%, p < 0.001 for both). As for documentation of significant IFs, only 49 of 112 chest IFs (43.8%) and 55 of 176 abdominopelvic IFs (31.3%) were documented. Investigating factors associated with documentation of clinically significant IFs, shorter length of hospital stay (1.5 (IQR: 0-4) vs. 3 (IQR: 2-8), p = 0.003), and discharging by ED physicians (documentation rate: 13.2% vs 42.6%, p < 0.001) were associated with poorer documentation of IFs only in abdominopelvic scans.
      Conclusion: CT imaging in ED trauma patients often reveals incidental findings, especially in older patients. Over 50% of these findings are clinically significant, yet they are frequently ignored and not documented. Physicians need to be more vigilant in recognizing and documenting these incidental findings and informing patients of the need for further evaluation.
      Competing Interests: Declaration of competing interest None of the authors has any conflict of interest to declare.
      (Copyright © 2024 Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Communication; Computed tomography; Emergency imaging; Incidental findings; Multiple trauma; Patient safety; Public health surveillance; Wound and injuries
    • Publication Date:
      Date Created: 20240620 Date Completed: 20240717 Latest Revision: 20240718
    • Publication Date:
      20240719
    • Accession Number:
      10.1016/j.ajem.2024.06.008
    • Accession Number:
      38901332