Prevalence of incidental findings in trauma patients detected by computed tomography imaging.
OBJECTIVE
The primary intention of spiral computed tomography (SCT) in trauma patients is to identify significant injuries. However, unanticipated information is often discovered. We hypothesize that SCT often identifies clinically significant incidental findings in trauma patients.


METHODS
This was a retrospective protocol chart review of consecutive adult trauma patients seen at a level I trauma center. A complete SCT was defined as computed tomography imaging of the head, cervical spine, chest, abdomen, and pelvis, thoracic, and lumbar spine. Incidental findings were classified into 2 categories: type 1, which requires urgent evaluation, and type 2, which requires informing the patient but does not mandate urgent follow-up.


RESULTS
We reviewed 3246 patient charts and 3092 met inclusion criteria. Type 1 findings were reported in 990 (32.0%; 95% confidence interval [CI], 30.4%-33.7%) patients. Type 2 findings were found in 1274 (41.2%; 95% CI, 39.5%-42.9%) patients. Female sex (odds ratio, 1.38; 95% CI, 1.16-1.65) and older age (odds ratio, 2.61; 95% CI, 2.33-2.93) were independently associated with a higher prevalence of type 1 findings. There were 631 incidental findings concerning for neoplasm, which included 196 pulmonary nodules, 99 liver, 36 renal, 23 brain, and 11 breast masses.


CONCLUSIONS
A significant number of trauma patients evaluated with SCT are diagnosed with potentially serious incidental findings. For long-term care and medicolegal concerns, physicians need to inform patients of these incidental findings and the need for further evaluation.
Barrett
Tyler W
TW
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-4700, USA. tyler.barrett@vanderbilt.edu
Schierling
Michelle
M
Zhou
Chuan
C
Colfax
J Drew
JD
Russ
Stephan
S
Conatser
Paige
P
Lancaster
Penny
P
Wrenn
Keith
K
D000328:Adult; D017677:Age Distribution; D004630:Emergencies; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D036542:Tomography, Spiral Computed; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology