title: Variability in management recommendations for incidental thyroid nodules detected on CT of the cervical spine in the emergency department.
abstract: OBJECTIVE
  Incidental thyroid nodules are common on CT. Variability in management recommendations for these nodules due to a lack of accepted CT base guidelines has not been demonstrated.
  
  
  METHODS
  Consecutive CT cervical spine radiology reports describing thyroid nodules performed in an emergency department from January 1, 2009, to December 31, 2011, were retrospectively reviewed. Number of nodules, nodule size, and type of recommended management were recorded.
  
  
  RESULTS
  Three hundred fifteen examinations met the inclusion criteria. The mean study age was 64 ± 20 years. Fifty-eight percent were women. Thirty percent (n = 95) of thyroid nodules measured <10 mm, 20% (n = 63) were ≥10 but <15 mm, 11% (n = 36) were ≥15 but <20 mm, and 15.5% (n = 49) were ≥20 mm. Size was not reported for 22.9% (n = 72). Two hundred twenty-seven recommendations were made in 181 (57.5%) studies. Recommendations were made for 51.6% (49 of 95) of nodules <10 mm, for 52.4% (33 of 63) of those ≥10 but <15 mm, for 83.3% (30 of 36) of those ≥15 but <20 mm, and for 81.6% (40 of 49) of those ≥20 mm. Management was recommended in 40.0% (29 of 72) of nodules with no size reported. Fifty-four percent (123 of 227) of recommendations were for ultrasound, followed by no follow-up recommended (17.2% [39 of 227]), clinical correlation (13.7% [31 of 227]), thyroid serology (6.2% [14 of 227]), clinical follow-up (4.8% [11 of 227]), comparison with prior studies (2.2% [5 of 227]), fine-needle aspiration (1.3% [3 of 227]), and nuclear scintigraphy (0.4% [1 of 227]). Nodule size was significantly associated with the likelihood of recommendation (odds ratio, 1.79; 95% confidence interval, 1.37-2.35).
  
  
  CONCLUSIONS
  Management recommendations for incidental thyroid nodules detected on cervical spine CT are made inconsistently, and the type of management recommended is variable.
authors.affiliation: Department of Radiology, University of Washington, Harborview Medical Center, Seattle, Washington. Electronic address: blehnert@u.washington.edu.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Lehnert
authors.affiliation: Department of Radiology, University of Washington, Harborview Medical Center, Seattle, Washington.
authors.forename: Claire K
authors.initials: CK
authors.lastname: Sandstrom
authors.affiliation: Department of Radiology, University of Washington, Harborview Medical Center, Seattle, Washington.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Gross
authors.affiliation: Department of Radiology, University of Washington Medical Center, Seattle, Washington.
authors.forename: Manjiri
authors.initials: M
authors.lastname: Dighe
authors.affiliation: Department of Radiology, University of Washington, Harborview Medical Center, Seattle, Washington.
authors.forename: Ken F
authors.initials: KF
authors.lastname: Linnau
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009333:Neck; D010346:Patient Care Management / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014861:Washington / Q000453:epidemiology
keywords: CT; Incidental thyroid nodule; cervical spine; emergency department; management guidelines; management recommendations; practice variability