title: Incidental findings on total-body CT scans in trauma patients.
abstract: BACKGROUND
  Total-body Computed Tomography (CT) scans are increasingly used in trauma care. Herewith the observation of incidental findings, trauma unrelated findings, is also increased. The aim of this study was to evaluate the number of incidental findings in adult trauma patients.
  
  
  METHODS
  All consecutive trauma patients that underwent total-body CT scanning between January 2009 and December 2011 were analysed. Incidental findings were divided in three categories: category I (potentially severe condition, further diagnostic work-up is required), category II (diagnostic work-up dependent on patients' symptoms) and category III (findings of minor concern, no diagnostic work-up required).
  
  
  RESULTS
  There were 2248 trauma room presentations; 321 patients underwent a total-body CT scan (14.3%). In 143 patients (44.5%), 186 incidental findings were reported. There were 13 category I findings (7.0%), 45 category II findings (24.2%) and 128 category III incidental findings (68.8%). Overall, 18 patients (5.6%) required additional diagnostic work-up. Four patients underwent work-up by additional radiologic imaging. Three patients required further invasive work-up or treatment. Three patients were transferred to another hospital, no extended follow-up was performed. In three patients, there was no documentation of follow-up. Five patients deceased before diagnostic work-up of the incidental finding could start.
  
  
  CONCLUSIONS
  Total-body CT scanning as part of the evaluation of trauma patients leads to a substantial amount of incidental findings. Documentation of incidental findings and their clinical consequences was incomplete. Therefore, the findings of this study have prompted us to add an item to our electronic trauma room report that obliges residents to report whether or not incidental findings are found during trauma imaging.
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: j.c.sierink@amc.nl.
authors.forename: J C
authors.initials: JC
authors.lastname: Sierink
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: t.p.saltzherr@amc.nl.
authors.forename: T P
authors.initials: TP
authors.lastname: Saltzherr
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: m.j.russchen@amc.nl.
authors.forename: M J A M
authors.initials: MJ
authors.lastname: Russchen
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: s.m.decastro@amc.nl.
authors.forename: S M M
authors.initials: SM
authors.lastname: de Castro
authors.affiliation: Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: l.f.beenen@amc.nl.
authors.forename: L F M
authors.initials: LF
authors.lastname: Beenen
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: n.w.schep@amc.nl.
authors.forename: N W L
authors.initials: NW
authors.lastname: Schep
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: j.c.goslings@amc.nl.
authors.forename: J C
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D033162:Incidental Findings; D008297:Male; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data; D014193:Trauma Centers; D051598:Whole Body Imaging / Q000379:methods / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Computed Tomography; Incidental findings; Injury; Total-body CT; Trauma