title: Incidental Findings on Bedside Ultrasonography: Detection Rate and Accuracy of Resident-Performed Examinations in the Acute Setting.
abstract: BACKGROUND
  Bedside ultrasonography has become a valuable tool in the emergent care setting for triage and rapid evaluation of patients who are acutely ill. Given the cross-sectional nature of ultrasound technology, incidental findings are frequently encountered during imaging. These can impact clinical management and can pose a diagnostic dilemma for emergency medicine (EM) physicians and EM residents.
  
  
  OBJECTIVE
  Our retrospective study was designed to evaluate the prevalence and detection rate of incidental findings on bedside ultrasound examinations performed by EM residents. We also sought to identify types of incidental findings encountered and the diagnostic accuracy of those findings.
  
  
  METHODS
  Board-certified radiologists retrospectively reviewed bedside ultrasonography examinations performed and interpreted by EM residents at a large urban academic hospital. Our sample included patients who presented with traumatic and nontraumatic symptoms in the acute setting. Findings were defined as incidental only if they were previously unknown and not related to a patients presenting symptoms. The results were corroborated with electronic medical records and additional pertinent imaging when available.
  
  
  RESULTS
  Of 196 examinations analysed, EM residents identified incidental findings on 26% of the studies, which mostly involved the renal and biliary system. Radiologist review detected incidental findings in 20.9% but was more accurate when supplemental imaging was available. EM residents detected incidental findings at rates similar to that published previously and had moderate interobserver agreement with radiologist review. Worrisome and indeterminate findings were confirmed by additional work-up and further imaging.
  
  
  CONCLUSIONS
  Incidental findings are frequently encountered on bedside ultrasonography and have the potential to alter clinical management. Expertise in detection and knowledge of the presence and spectrum of these incidental findings is essential for appropriate triage, patient management, and follow-up.
authors.affiliation: Department of Radiology, ER Division, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Anuj
authors.initials: A
authors.lastname: Tewari
authors.affiliation: Department of Radiology, ER Division, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Waqas
authors.initials: W
authors.lastname: Shuaib
authors.affiliation: Department of Radiology, ER Division, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Maddu
authors.affiliation: Department of Radiology, ER Division, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Ninad
authors.initials: N
authors.lastname: Salastekar
authors.affiliation: Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Sierra
authors.initials: S
authors.lastname: Beck
authors.affiliation: Department of Radiology, ER Division, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Jamlik-Omari
authors.initials: JO
authors.lastname: Johnson
authors.affiliation: Department of Radiology, ER Division, Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address: faisal.khosa@emoryhealthcare.org.
authors.forename: Faisal
authors.initials: F
authors.lastname: Khosa
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007396:Internship and Residency; D007674:Kidney Diseases / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D019095:Point-of-Care Systems; D011871:Radiology; D012189:Retrospective Studies; D014463:Ultrasonography
keywords: Bedside Ultrasound; Emergency Medicine; Incidental Findings