title: Optimal management strategy for incidental findings in trauma patients: an initiative for midlevel providers.
abstract: BACKGROUND
  Increasing patient volume and residents' work hour restrictions have increased the workload at trauma centers. Further, comprehensive tertiary surveys after initial stabilization and appropriate follow-up plans for incidental findings are time consuming. Midlevel providers (MLP) can help streamline this process. We initiated a care plan in which MLPs conducted all tertiary surveys and coordinated follow-ups for incidental findings.
  
  
  METHODS
  From November 2005 through May 2006, we implemented a MLP-driven initiative aimed at performing tertiary surveys within 48 hours of admission on all trauma patients admitted to our Level-1 trauma center. Tertiary surveys consisted of a complete history and physical, radiographic evaluations and appropriate consultations. Incidental findings were recorded and communicated to the trauma attending. A follow-up plan was devised, and the course of action was documented. Patients or family members were informed, and their acknowledgments were filed. Data are presented as mean +/- SE.
  
  
  RESULTS
  There were 1,027 patients admitted during the study period. Blunt mechanisms accounted for 81% of the injuries (primarily motor vehicle crashes and falls). Seventy-six patients had 87 incidental findings (7.4%); 53 were men. The mean age was 51.8 years +/- 2.1 years and mean injury severity score was 18.5 +/- 1.4. Incidental findings of clinical significance included 18 pulmonary nodules or neoplasms, 9 adrenal masses (>4 mm), 7 patients with lymphadenopathy, 5 benign cystic lesions, and 3 renal masses. Other neoplastic lesions included bladder (2), thyroid (2), ovary (1), breast (1), and rectum (1).
  
  
  CONCLUSIONS
  With prevalent medicolegal pressure and restricted residents' work hours, a MLP-initiative to streamline the tertiary survey effectively addresses incidental findings. This MLP-driven care plan can help reduce residents' workload, provides appropriate follow-up, and minimizes legal risks inherent to incidental findings on the trauma service.
authors.affiliation: F.H. Sammy Ross Jr. Trauma Center, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA. toan.huynh@carolinashealthcare.org
authors.forename: Toan T
authors.initials: TT
authors.lastname: Huynh
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Moran
authors.forename: Angela H
authors.initials: AH
authors.lastname: Blackburn
authors.forename: David G
authors.initials: DG
authors.lastname: Jacobs
authors.forename: Michael H
authors.initials: MH
authors.lastname: Thomason
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
mesh_terms: D000307:Adrenal Gland Diseases / Q000453:epidemiology; D000328:Adult; D015897:Comorbidity; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D033162:Incidental Findings; D015601:Injury Severity Score; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D009657:North Carolina; D024802:Nurse's Role; D011446:Prospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000453:epidemiology*