title: Improving patient notification of solid abdominal viscera incidental findings with a standardized protocol.
abstract: BACKGROUND
  The increasing use of computed tomography (CT) scans in the evaluation of trauma patients has led to increased detection of incidental radiologic findings. Incidental findings (IFs) of the abdominal viscera are among the most commonly discovered lesions and can carry a risk of malignancy. Despite this, patient notification regarding these findings is often inadequate.
  
  
  METHODS
  We identified patients who underwent abdominopelvic CTs as part of their trauma evaluation during a recent 1-year period (9/2011-8/2012). Patients with IFs of the kidneys, liver, adrenal glands, pancreas and/or ovaries had their charts reviewed for documentation of the lesion in their discharge paperwork or follow-up. A quality improvement project was initiated where patients with abdominal IFs were verbally informed of the finding, it was noted on their discharge summary and/or were referred to specialists for evaluation. Nine months after the implementation of the IF protocol, a second chart review was performed to determine if the rate of patient notification improved.
  
  
  RESULTS
  Of 1,117 trauma patients undergoing abdominopelvic CT scans during the 21 month study period, 239 patients (21.4%) had 292 incidental abdominal findings. Renal lesions were the most common (146 patients, 13% of all patients) followed by hepatic (95/8.4%) and adrenal (38/3.4%) lesions. Pancreatic (10/0.9%) and ovarian lesions (3/0.3%) were uncommon. Post-IF protocol implementation patient notification regarding IFs improved by over 80% (32.4% vs. 17.7% pre-protocol, p = 0.02).
  
  
  CONCLUSIONS
  IFs of the solid abdominal organs are common in trauma patients undergoing abdominopelvic CT scan. Patient notification regarding these lesions is often inadequate. A systematic approach to the documentation and evaluation of incidental radiologic findings can significantly improve the rate of patient notification.
authors: University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA.
authors: Courtney E
authors: CE
authors: Collins
authors: University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA.
authors: Nicole
authors: N
authors: Cherng
authors: University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA.
authors: Theodore
authors: T
authors: McDade
authors: University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA.
authors: Babak
authors: B
authors: Movahedi
authors: University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA.
authors: Timothy A
authors: TA
authors: Emhoff
authors: University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA.
authors: Giles F
authors: GF
authors: Whalen
authors: University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA.
authors: Jennifer
authors: J
authors: LaFemina
authors: University of Massachusetts Medical School and UMass Memorial, Worcester, MA USA.
authors: Jon D
authors: JD
authors: Dorfman
keywords: Abdominal CT; Computed tomography; Incidental finding; Quality improvement; Trauma