Incidental CT findings in trauma patients spark concern for physicians

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Nearly one-fifth of trauma patients who undergo CT evaluation have incidental findings that are easily detectable, according to a study published this month in the American Journal of Roentgenology.

The purpose of the study, performed by Columbus Radiology at Grant Medical Center in Columbus, Ohio, was to determine the frequency and types of incidental findings in the cervical spines of trauma patients undergoing CT.

The researchers accessed the trauma registry to identify the cases of patients evaluated with cervical spine CT at a Level 1 trauma center from January to July 2007. Trauma registry data, including age, sex, injury severity score, mechanism of injury, length of stay, and diagnosis were recorded, and all CT scans of the cervical spine were reviewed for incidental findings. Clinically significant incidental findings were classified according to body location, and the association between various patient characteristics and the likelihood of an incidental finding was assessed.

"There are a lot of CT scans performed and as technology has advanced we are beginning to image more and more anatomy. With that we are identifying more incidental findings," said Shella Farooki, MD, lead author of the study. "Our study found that patients who were older and had a higher injury severity score were more likely to have incidental findings. Additionally, injuries related to falls vs. motor accidents had a higher percentage of incidental findings."

Farooki and colleagues identified incidental CT findings in 230 of 1,256 patients who underwent CT of the cervical spine during an initial trauma evaluation. They stratified the incidental findings as trauma-related and not trauma-related. The likelihood of non-trauma-related incidental findings was associated with age and the likelihood of trauma-related incidental findings was associated with injury severity score.

Incidental findings in the cervical spine were associated with age, injury severity score, and mechanism of injury. Awareness of the prevalence of incidental findings is important to assuring that both traumatic and nontraumatic pathologic findings are detected and appropriately managed.

"A lot of patients come into the ER as trauma patients, but are leaving with diagnoses that are not related to trauma. As a physician, you have to pay attention to detail in communicating and following up is important," Farooki said.