title: High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial.
abstract: OBJECTIVE
  To determine whether there is a difference in frequency and clinical relevance of incidental findings detected by total-body computed tomography scanning (TBCT) compared to those by the standard work-up (STWU) with selective computed tomography (CT) scanning.
  
  
  METHODS
  Trauma patients from five trauma centres were randomized between April 2011 and January 2014 to TBCT imaging or STWU consisting of conventional imaging with selective CT scanning. Incidental findings were divided into three categories: 1) major finding, may cause mortality; 2) moderate finding, may cause morbidity; and 3) minor finding, hardly relevant. Generalized estimating equations were applied to assess differences in incidental findings.
  
  
  RESULTS
  In total, 1083 patients were enrolled, of which 541 patients (49.9 %) were randomized for TBCT and 542 patients (50.1 %) for STWU. Major findings were detected in 23 patients (4.3 %) in the TBCT group compared to 9 patients (1.7 %) in the STWU group (adjusted rate ratio 2.851; 95%CI 1.337-6.077; p < 0.007). Findings of moderate relevance were detected in 120 patients (22.2 %) in the TBCT group compared to 86 patients (15.9 %) in the STWU group (adjusted rate ratio 1.421; 95%CI 1.088-1.854; p < 0.010).
  
  
  CONCLUSIONS
  Compared to selective CT scanning, more patients with clinically relevant incidental findings can be expected by TBCT scanning.
  
  
  CONCLUSIONS
  • Total-body CT scanning in trauma results in 1.5 times more incidental findings. • Evaluation by TBCT in trauma results in more patients with incidental findings. • In every category of clinical relevance, TBCT detects more incidental findings.
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. k.treskes@amc.nl.
authors.forename: K
authors.initials: K
authors.lastname: Treskes
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: S A
authors.initials: SA
authors.lastname: Bos
authors.affiliation: Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: L F M
authors.initials: LFM
authors.lastname: Beenen
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Sierink
authors.affiliation: Department of Trauma and emergency surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
authors.forename: M J R
authors.initials: MJR
authors.lastname: Edwards
authors.affiliation: Trauma Unit, Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
authors.forename: B J A
authors.initials: BJA
authors.lastname: Beuker
authors.affiliation: Department of Radiology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: G S R
authors.initials: GSR
authors.lastname: Muradin
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Hohmann
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: J S K
authors.initials: JSK
authors.lastname: Luitse
authors.affiliation: Department of Anaesthesiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: Hollmann
authors.affiliation: Clinical Research Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: M G W
authors.initials: MGW
authors.lastname: Dijkgraaf
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed / Q000379:methods; D014193:Trauma Centers; D051598:Whole Body Imaging / Q000379:methods; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*
keywords: Incidental findings; Multidetector computed tomography; Multiple trauma; Total-body CT; Wounds and injuries