Most incidental findings on trauma CT go uncaptured

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 - Emergency

As emergency CT has grown in use, incidental findings in trauma patients have multiplied. No surprise there, but a study conducted at a level-1 trauma center in New York City suggests that documentation of incidental findings may be seriously lacking, with obvious potential implications for follow-up care.

Melissa James, PhD, and colleagues at Jamaica Hospital Medical Center in Queens retrospectively reviewed 1,573 CT images acquired from 416 patients during trauma assessment while prospectively documenting incidental findings over a six-month period.

Analyzing the frequency of incidental findings and follow-up referrals, they found that 478 of the scans (30.4 percent) revealed 858 incidental findings—average, three per patient—yet only 12 such findings, 1.4 percent, were documented in a discharge note.

They also found the abdomen/pelvis had the highest rate of incidental findings (61.7 percent), follow-up was required for 24 incidental findings (2.8 percent), and admission/immediate intervention was required for six findings (0.7 percent).

Meanwhile, using logistic regression to identify independent risk factors, the researchers found that increasing age, a higher body mass index and receiving a pan (whole-body) CT increased the odds of having an incidental finding (p < 0.001, p = 0.015 and p < 0.001, respectively).

“A large percentage of trauma patients have incidental findings,” James and colleagues conclude. “Therefore, better documentation and follow-up are needed to determine the long-term outcomes of patients with clinically relevant incidental findings.”

The study is running in the August edition of Emergency Radiology.