Incidental findings in blunt trauma patients: prevalence, follow-up documentation, and risk factors.
OBJECTIVE
The frequency of computed tomography (CT) imaging of trauma patients has given rise to an increase in the discovery of incidental findings. The purpose of this study was to evaluate the frequency and documentation of follow-up recommendations of incidental findings during the initial trauma evaluation. Secondarily, trauma patients with and without incidental findings were compared. We hypothesized that there would be a high rate of incidental findings in trauma patients and that these findings would be poorly documented.


METHODS
A retrospective review of CT imaging performed during trauma assessment at an urban level 1 trauma center was conducted. Prospectively documented incidental findings over a 6-month period were recorded. The frequency of incidental findings and follow-up referrals were analyzed. Mann-Whitney non-parametric test and Fisher's exact test were used to compare patients with and without incidental findings, and logistic regression was performed to identify independent risk factors.


RESULTS
Of the 1573 CT scans performed, 478 (30.4%) revealed incidental findings. The abdomen/pelvis had the highest rate of incidental findings (61.7%). Of the 416 patients, 295 (70.9%) had a total of 858 incidental findings, with an average of 3 findings per patient. Follow-up was required for 24 (2.8%) incidental findings, and admission/immediate intervention was required for 6 (0.7%) findings. Only 12 (1.4%) incidental findings were documented in the discharge note. Increasing age (p < 0.001), a higher body mass index (BMI) (p = 0.015), and receiving a pan-CT (p < 0.001) increased the odds of having an incidental finding.


CONCLUSIONS
A large percentage of trauma patients have incidental findings. Therefore, better documentation and follow-up are needed to determine the long-term outcomes of patients with clinically relevant incidental findings.
Department of Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY, 11418, USA.
Melissa K
MK
James
School of Medicine, Ross University, Roseau, Dominica.
Michael P
MP
Francois
Department of Radiology, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY, 11418, USA.
Gideon
G
Yoeli
Department of Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY, 11418, USA.|Department of Emergency Medicine, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY, 11418, USA.
Geoffrey K
GK
Doughlin
Department of Emergency Medicine, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, NY, 11418, USA. slee@jhmc.org.
Shi-Wen
SW
Lee
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000401:mortality
CT; Incidental findings; Incidentalomas; Pan-scan; Trauma