title: Incidental findings in focused assessment with sonography for trauma in hemodynamically stable blunt trauma patients: speaking about cost to benefit.
abstract: BACKGROUND
  The purpose of this study was to identify which age-related groups of hemodynamically stable blunt trauma patients will present a positive cost-to-benefit ratio, in regard to the screening of incidental findings on Focused Assessment with Sonography for Trauma (FAST).
  
  
  METHODS
  We conducted a prospective study using retrospective data taken from the trauma registry of 6,041 consecutive hemodynamically stable blunt trauma patients who underwent FAST at our Level I urban trauma hospital during the year 2009. A receiver operating characteristic curve was used to determine whether age level is useful in detecting organ-/system-specific incidental findings in trauma patients undergoing FAST and to establish the required diagnostic cutoff value of this selected test. A cost-benefit analysis was then performed for the age-specific cutoff values of each organ/system evaluated by FAST.
  
  
  RESULTS
  We found 522 incidental findings in 468 patients (7.8%). Further diagnostic workup was instructed in 35% (168 of 468) of patients with incidental findings. The cost-benefit analysis for the age-specific cutoff values found in the receiver operating characteristic curve analysis showed that the project of screening for incidental findings on FAST was viable only when the ultrasound operator additionally searches the liver/biliary tree (≥43 years) and the kidneys (≥56 years).
  
  
  CONCLUSIONS
  A systematic examination of the liver and biliary tree and both kidneys of specific age groups during FAST screening of hemodynamically stable blunt trauma patients may disclose a potentially unknown pathology with a positive cost-to-benefit ratio.
authors.affiliation: Second Surgical Department and Surgical Oncology Unit, Korgialenio-Benakio, Red Cross Hospital, Athens, Greece. ggsgourakis@yahoo.gr
authors.forename: George
authors.initials: G
authors.lastname: Sgourakis
authors.forename: Sophocles
authors.initials: S
authors.lastname: Lanitis
authors.forename: Maria
authors.initials: M
authors.lastname: Korontzi
authors.forename: Christos
authors.initials: C
authors.lastname: Kontovounisios
authors.forename: Constantine
authors.initials: C
authors.lastname: Zacharioudakis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Armoutidis
authors.forename: Charilaos
authors.initials: C
authors.lastname: Karaliotas
authors.forename: Georgia
authors.initials: G
authors.lastname: Dedemadi
authors.forename: Nicki
authors.initials: N
authors.lastname: Lepida
authors.forename: Constantine
authors.initials: C
authors.lastname: Karaliotas
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006115:Greece; D017048:Health Care Costs; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D066298:In Vitro Techniques; D033162:Incidental Findings; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000191:economics* / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000191:economics / Q000601:surgery; D055815:Young Adult