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Incidental radiographic findings after injury: dedicated attention results in improved capture, documentation, and management.

Published on Oct 1, 2010in Surgery3.476
· DOI :10.1016/j.surg.2010.07.017
Jason L. Sperry39
Estimated H-index: 39
(University of Pittsburgh),
Margaret S. Massaro1
Estimated H-index: 1
(University of Pittsburgh)
+ 7 AuthorsAndrew B. Peitzman54
Estimated H-index: 54
(University of Pittsburgh)
Abstract
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 documentation of incidental finding events. Methods A quality-improvement project to record and follow-up incidental findings postinjury was initiated at our level I trauma center (April 2007–March 2008, prededicated incidental finding). Because of concerns for inadequate documentation of identified incidental finding events, we implemented a dedicated incidental finding coordinator (April 2008–March 2009, postdedicated incidental finding). The dedicated incidental finding coordinator documented incidental findings daily from trauma admission radiology final reads. Incidental findings were divided into 3 groups; category 1: attention prior to discharge; category 2: follow-up with primary doctor within 2 weeks; category 3: no specific follow-up. For category 1 incidental findings, in-hospital consultation of the appropriate service was verified. On discharge, patient notification, follow-up, and documentation of events were confirmed. Certified mail or telephone contact was used to notify either the patient or the primary doctor in those who lacked appropriate notification or documentation. Results Admission rates and incidental finding categories were similar across the 2 time periods. Implementation of a dedicated incidental finding coordinator resulted in more than a 165% increase in incidental finding capture ( n = 802 vs n = 302; P Conclusion The implementation of a dedicated incidental finding coordinator resulted in more than a 2.5-fold higher capture of incidental findings. Dedicated attention to incidental findings resulted in a near complete initiation of patient notification, follow-up, and hospital record documentation of incidental finding events. Inadequate patient notification and follow-up would delay appropriate care and potentially would result in morbidity or even mortality. A dedicated incidental finding coordinator represents a potential solution to this patient-care and medical–legal dilemma.
  • References (21)
  • Citations (18)
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References21
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#1Marc-David Munk (University of Pittsburgh)H-Index: 3
#2Andrew B. Peitzman (University of Pittsburgh)H-Index: 54
Last. Allan B. Wolfson (University of Pittsburgh)H-Index: 21
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Objectives: Incidental findings found on computed tomography (CT) scan during the Emergency Department evaluation of trauma patients are often benign, but their presence must always be communicated to patients, who should be referred for follow-up care. Our objective was to quantify the frequency of these incidental CT findings in trauma patients. A secondary goal was to determine how often these lesions were communicated to patients and how often patients were referred for follow-up. Methods: W...
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INTRODUCTION: This study was performed to determine the agreement between and within surgeons concerning the influence on treatment plan of routine versus selective multidetector-row computed tomography (MDCT) findings in blunt trauma patients. PATIENTS: For this study, 50 patients were randomly selected from a customized database that was originally used to compare a diagnostic algorithm with a selective use of MDCT with an algorithm with routine MDCT of the spine, chest, and abdomen within the...
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Objective:Many trauma centers use the pan-computed tomography (CT) scan (head, neck, chest, and abdomen/pelvis) for the evaluation of blunt trauma. This prospective observational study was undertaken to determine whether a more selective approach could be justified.Methods:We evaluated injuries in b
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#2Yeung Yam (U of O: University of Ottawa)H-Index: 16
Last. Benjamin J.W. Chow (U of O: University of Ottawa)H-Index: 36
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Objectives We sought to determine the incidence, clinical significance, and potential financial impact of noncardiac incidental findings (IF) identified with cardiac computed tomography (CT). Background Cardiac CT is gaining acceptance and may lead to the frequent discovery of extracardiac IF. Methods Consecutive patients undergoing cardiac CT had noncardiac structures evaluated after full field of view (32 to 50 cm) reconstruction. IF were categorized as clinically significant (CS), indetermina...
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Background: We have used single-contrast (intravenous contrast only) computed tomography (SCCT) for triaging hemodynamically stable patients with penetrating torso trauma. We hypothesized that SCCT safely determines the need for operative exploration. Furthermore, trauma surgeons without specialized training in body imaging can accurately apply this modality. Methods: We retrospectively reviewed the records of patients with penetrating torso injuries at a university-based urban trauma center to ...
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Summary Background The number of trauma centres using whole-body CT for early assessment of primary trauma is increasing. There is no evidence to suggest that use of whole-body CT has any effect on the outcome of patients with major trauma. We therefore compared the probability of survival in patients with blunt trauma who had whole-body CT during resuscitation with those who had not. Methods In a retrospective, multicentre study, we used the data recorded in the trauma registry of the German Tr...
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Abstract Background Incidental findings (IFs) are common among injured patients and create a complex problem with no standardized solution. Materials and methods This is a retrospective review of adult trauma patients admitted to a level I trauma center from January to May 2017. IFs from abdominal, chest, and neck imaging were categorized based on previously published guidelines focused on clinically significant IFs. Patient demographics related to access to care were collected. Outcome measures...
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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...
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Abstract Background Radiologic imaging of trauma patients often uncovers findings that are unrelated to the trauma. These are termed as incidental findings and identifying them in radiology examination reports is necessary for appropriate follow-up. We developed and evaluated an automated pipeline to identify incidental findings at sentence and section levels in radiology reports of trauma patients. Methods We created an annotated dataset of 4,181 reports and investigated automated feature repre...
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Abstract Background Incidental findings are prevalent in imaging but often go unreported to patients. Such unreported findings may present the potential for harm as well as medico-legal ramifications. Methods A chart review of trauma patients was undertaken over a year. Systems-based changes were made utilizing our electronic medical record system and our staff protocols to improve the disclosure of clinically relevant incidental findings to patients. Results During the preintervention period, 6...
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