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Incidental findings on total-body CT scans in trauma patients.

Published on May 1, 2014in Injury-international Journal of The Care of The Injured1.83
· DOI :10.1016/j.injury.2013.10.009
Joanne C. Sierink9
Estimated H-index: 9
,
Teun Peter Saltzherr13
Estimated H-index: 13
+ 4 AuthorsJ. C. Goslings16
Estimated H-index: 16
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Abstract
Abstract Introduction Total-body Computed Tomography (CT) scans are increasingly used in trauma care. Herewith the observation of incidental findings, trauma unrelated findings, is also increased. The aim of this study was to evaluate the number of incidental findings in adult trauma patients. Patients and methods All consecutive trauma patients that underwent total-body CT scanning between January 2009 and December 2011 were analysed. Incidental findings were divided in three categories: category I (potentially severe condition, further diagnostic work-up is required), category II (diagnostic work-up dependent on patients’ symptoms) and category III (findings of minor concern, no diagnostic work-up required). Results There were 2248 trauma room presentations; 321 patients underwent a total-body CT scan (14.3%). In 143 patients (44.5%), 186 incidental findings were reported. There were 13 category I findings (7.0%), 45 category II findings (24.2%) and 128 category III incidental findings (68.8%). Overall, 18 patients (5.6%) required additional diagnostic work-up. Four patients underwent work-up by additional radiologic imaging. Three patients required further invasive work-up or treatment. Three patients were transferred to another hospital, no extended follow-up was performed. In three patients, there was no documentation of follow-up. Five patients deceased before diagnostic work-up of the incidental finding could start. Conclusion Total-body CT scanning as part of the evaluation of trauma patients leads to a substantial amount of incidental findings. Documentation of incidental findings and their clinical consequences was incomplete. Therefore, the findings of this study have prompted us to add an item to our electronic trauma room report that obliges residents to report whether or not incidental findings are found during trauma imaging.
  • References (23)
  • Citations (35)
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References23
Newest
Published on Feb 1, 2014in Emergency Medicine Journal2.31
Donagh Healy14
Estimated H-index: 14
(UL: University of Limerick),
Aidan Hegarty1
Estimated H-index: 1
(University Hospital Limerick)
+ 3 AuthorsStewart R. Walsh Mb BCh MRCSEd43
Estimated H-index: 43
(UL: University of Limerick)
Background Full-body CT scanning is increasingly being used in the initial evaluation of severely injured patients. We sought to analyse the literature to determine the benefits of full-body scanning in terms of mortality and length of time spent in the emergency department (ED). Methods A systematic search of the Pubmed and Cochrane Library databases was performed. Eligible studies compared trauma patients managed with selective CT scanning with patients who underwent immediate full-body scanni...
Published on Mar 1, 2013in American Journal of Surgery2.20
Tutu Cheng1
Estimated H-index: 1
(Conemaugh Health System),
Russell Dumire4
Estimated H-index: 4
(Conemaugh Health System)
+ 1 AuthorsJames S. Gregory2
Estimated H-index: 2
(Conemaugh Health System)
Abstract Background Overnight radiology services (ORSs) provide computed tomography (CT) scan readings that are automatically reviewed by staff radiologists (SRs) and the trauma service. Discordant readings and their clinical significance were investigated. Methods ORS-read CT scans over 3 years were reviewed. A discordant reading was clinically significant if it resulted in a substantive change in patient care. All clinically significant findings were reviewed by a blinded radiologist. Results ...
Raoul van Vugt4
Estimated H-index: 4
,
Digna R. Kool16
Estimated H-index: 16
+ 1 AuthorsMichael J. Edwards54
Estimated H-index: 54
BACKGROUND: Currently, total body computed tomography (TBCT) is rapidly implemented in the evaluation of trauma patients. With this review, we aim to evaluate the clinical implications-mortality, change in treatment, and time management-of the routine use of TBCT in adult blunt high-energy trauma patients compared with a conservative approach with the use of conventional radiography, ultrasound, and selective computed tomography. METHODS: A literature search for original studies on TBCT in blunt...
Raoul van Vugt4
Estimated H-index: 4
,
Helena M. Dekker22
Estimated H-index: 22
+ 5 AuthorsMichael J. Edwards54
Estimated H-index: 54
Thoracoabdominal MultiDetector-row Computed Tomography (MDCT) is frequently used as a diagnostic tool in trauma patients. One potential side-effect of performing MDCT is the detection of incidental findings and their subsequent consequences on medical treatment. The objective was to evaluate frequency and effects of incidental findings in trauma patients. The reports of 1,047 consecutive blunt trauma patients (mean age, 40 years) who underwent routine contrast-enhanced thoracoabdominal MDCT were...
Kasra Ahmadinia1
Estimated H-index: 1
,
J. Smucker1
Estimated H-index: 1
+ 1 AuthorsHeather A. Vallier21
Estimated H-index: 21
Background:Computed tomography (CT) scans have become imaging modalities of choice in trauma centers. The purposes of this study were to evaluate the trend of radiation exposure in acute trauma patients. Our hypothesis was that radiation dosage and charges would increase over time without change in
B. Loewenhardt3
Estimated H-index: 3
,
Michael Buhl2
Estimated H-index: 2
+ 7 AuthorsM. Bernhard21
Estimated H-index: 21
Abstract Background Whole-body computed tomography (WBCT) plays an important role in the management of severely injured patients. We evaluated the radiation exposure of WBCT scans using different positioning boards and arm positions. Methods In this retrospective study, the radiation exposure of WBCT using a 16-slice multislice computed tomography scanner was evaluated. Individual effective doses ( E , mSV) was calculated. Patients were assigned to two groups according to placement on a plastic ...
Published on Jan 1, 2012in British Journal of Surgery5.59
Joanne C. Sierink9
Estimated H-index: 9
,
Teun Peter Saltzherr13
Estimated H-index: 13
+ 3 AuthorsJ. C. Goslings16
Estimated H-index: 16
Background: The aim of this review was to assess the value of immediate total-body computed tomography (CT) during the primary survey of injured patients compared with conventional radiographic imaging supplemented with selective CT. Methods: A systematic search of the literature was performed in MEDLINE, Embase, Web of Science and Cochrane Library databases. Reports were eligible if they contained original data comparing immediate total-body CT with conventional imaging supplemented with select...
Published on Mar 1, 2011in Radiologic Clinics of North America1.88
Leonard Berlin25
Estimated H-index: 25
(Rush Medical College)
In October 2006, an 83-year-old, small, fraillooking woman, with a history of chronic obstructive pulmonary disease and smoking a pack of cigarettes daily for the previous 50 years, visited her family internist with complaints of cough and shortness of breath. Her physician referred her to the outpatient radiology department of a local hospital, where on October 19, 2006 she underwent posterior-anterior and lateral chest radiographies. A radiologist interpreted the examination as disclosing “evi...
Published on Jan 1, 2011in Emergency Medicine International
Ryan Thompson3
Estimated H-index: 3
,
Susan Wojcik11
Estimated H-index: 11
(State University of New York Upstate Medical University)
+ 1 AuthorsPaul Y. Ko2
Estimated H-index: 2
(State University of New York Upstate Medical University)
Objectives. Incidental findings on computed tomography (CT) scans are common. We sought to examine rates of findings and disclosure among discharged patients who received a CT scan in the ED. Methods. Retrospective chart review (Aug-Oct 2009) of 600 patients age 18 and older discharged home from an urban Level 1 trauma center. CT reports were used to identify incidental findings and discharge paperwork was used to determine whether the patient was informed of these findings. Results. There were ...
Published on Oct 1, 2010in Surgery3.48
Jason L. Sperry37
Estimated H-index: 37
(University of Pittsburgh),
Margaret S. Massaro1
Estimated H-index: 1
(University of Pittsburgh)
+ 7 AuthorsAndrew B. Peitzman53
Estimated H-index: 53
(University of Pittsburgh)
Background With liberal use of computed tomography in the diagnostic management of trauma patients, incidental findings are common and represent a major patient-care and medical–legal concern. Consequently, we began an initiative to capture, notify, and documentadequately incidental finding events with a dedicated incidental finding coordinator. We hypothesized a dedicated incidental finding coordinator would increase incidental finding capture and promote notification, follow-up, and documentat...
Cited By35
Newest
Published on Oct 1, 2019in Journal of Surgical Research1.87
Nathaniel Bell12
Estimated H-index: 12
,
Amanda K. Arrington12
Estimated H-index: 12
+ 4 AuthorsJan M. Eberth12
Estimated H-index: 12
Abstract Background This study evaluates whether trauma patients who incidentally learned about a malignancy have similar long-term outcomes as patients who organically learned about their malignancy. Materials and methods Incidental findings (IF) patients were matched to noninjured cancer controls on age group, sex, cancer site, stage, and year of diagnosis. Unadjusted covariates included race, insurance type, rural residence, and time from diagnosis to first cancer intervention. Cox proportion...
Published on Jul 1, 2019in European Radiology3.96
Eduardo J. Mortani Barbosa11
Estimated H-index: 11
(UPenn: University of Pennsylvania),
Oladayo Osuntokun (UPenn: University of Pennsylvania)
Objectives Whole-body CT scans are commonly performed to assess trauma patients, and often reveal incidental findings (IFs) the patient may be unaware of. We assessed the prevalence, associations, and adequacy of follow-up of IFs.
Published on Jul 1, 2019in Respirology case reports
Rachel Leonard (UVA: University of Virginia), Charles Schultz (UVA: University of Virginia), Sarah Hadique (UVA: University of Virginia)
Published on Jun 1, 2019in Journal of The American Academy of Dermatology7.10
Marilyn T. Wan3
Estimated H-index: 3
(UPenn: University of Pennsylvania),
Drew A. Torigian38
Estimated H-index: 38
(HUP: Hospital of the University of Pennsylvania)
+ 9 AuthorsThomas Werner9
Estimated H-index: 9
(HUP: Hospital of the University of Pennsylvania)
Background There has been an increase in the number of psoriasis treatments being investigated in clinical trials. Patients may have undiagnosed issues at the start of a study which may become identified during follow-up as incident medicinal conditions. The prevalence of incidental findings in patients with moderate-to-severe psoriasis presenting for clinical trials is unknown. Objective Determine the prevalence of incidentalomas and rate of malignancy identified by fludeoxyglucose F 18 (FDG) p...
Published on Mar 27, 2019in Acute medicine and surgery
Keisuke Kumada3
Estimated H-index: 3
(Gidai: Gifu University),
Nobuo Murakami22
Estimated H-index: 22
(Gidai: Gifu University)
+ 3 AuthorsTakahiko Asano14
Estimated H-index: 14
(Gidai: Gifu University)
Published on Dec 1, 2018in American Journal of Surgery2.20
Kristen Harkey (Carolinas Medical Center), Nicole Kaiser (Carolinas Medical Center)+ 1 AuthorsCaroline E. Reinke2
Estimated H-index: 2
(Carolinas Medical Center)
Abstract Background Surgical follow-up allows patients to discuss pathology and preventative maintenance. Multiple factors impact patients’ compliance with surgical follow-up. We hypothesized that increased travel time would be associated with lack of post-discharge surgical follow-up. Methods Retrospective analysis identified patients undergoing laparoscopic appendectomy or laparoscopic cholecystectomy. Descriptive statistics and logistic regression assessed the relationship between patient cha...
Published on Nov 1, 2018in Neuroradiology2.50
Elham Beheshtian (Johns Hopkins University), Sadaf Sahraian1
Estimated H-index: 1
(Johns Hopkins University)
+ 1 AuthorsMajid K. Khan (Johns Hopkins University)
Purpose Imaging of the cervical spine for trauma or degenerative disease includes multiple areas of the head and neck that may harbor incidental findings. We sought to determine the incidence of common “incidentalomas” on cervical spine CT scans, their importance, and how often these lesions are mentioned in reports.
Hans-Georg Palm7
Estimated H-index: 7
,
M. Kulla9
Estimated H-index: 9
+ 4 AuthorsTraumaRegistrer Dgu
Objectives Whole-body computed tomography (WBCT) plays an increasingly important role in the diagnostic assessment of trauma room patients. It is still unclear whether its use has led to changes of trauma room procedures and patient outcomes.
Published on Aug 1, 2018in Emergency Radiology
Mia Pries-Heje1
Estimated H-index: 1
(Gentofte Hospital),
Rasmus Bo Hasselbalch2
Estimated H-index: 2
(Gentofte Hospital)
+ 11 AuthorsMichel C. Nèmery (Gentofte Hospital)
Background Several large trials have evaluated the effect of CT screening based on specific symptoms, with varying outcomes. Screening of patients with CT based on their prognosis alone has not been examined before. For moderate-to-high risk patients presenting in the emergency department (ED), the potential gain from a CT scan might outweigh the risk of radiation exposure. We hypothesized that an accelerated “multiple rule out” CT screening of moderate-to-high risk patients will detect many cli...
C. Onwubiko1
Estimated H-index: 1
(UMMC: University of Mississippi Medical Center),
D. P. Mooney1
Estimated H-index: 1
(Boston Children's Hospital)
Purpose Computed tomography scans of the abdomen/pelvis (CTAP) in the adult population may reveal findings unrelated to the injury, such as a mass; the occurrence of incidental findings in pediatric patients remains unknown. This study aims to determine the percentage of pediatric trauma patients with incidental findings.