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

Published on Oct 1, 2010in Surgery3.48
· DOI :10.1016/j.surg.2010.07.017
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)
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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 < .001). Patient notification was attempted, and appropriate documentation of events was confirmed in 99.8% of patients. Patient notification was verified, and follow-up was initiated in 95.8% of cases. 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 (15)
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References21
Newest
Published on Apr 1, 2010in Journal of Emergency Medicine1.25
Marc-David Munk3
Estimated H-index: 3
(University of Pittsburgh),
Andrew B. Peitzman53
Estimated H-index: 53
(University of Pittsburgh)
+ 1 AuthorsAllan B. Wolfson21
Estimated H-index: 21
(University of Pittsburgh)
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...
Jaap Deunk11
Estimated H-index: 11
,
Monique Brink11
Estimated H-index: 11
+ 4 AuthorsMichael J. R. Edwards9
Estimated H-index: 9
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...
Published on Oct 1, 2009in Journal of the American College of Cardiology18.64
Jimmy MacHaalany11
Estimated H-index: 11
(U of O: University of Ottawa),
Yeung Yam16
Estimated H-index: 16
(U of O: University of Ottawa)
+ 4 AuthorsBenjamin J.W. Chow37
Estimated H-index: 37
(U of O: University of Ottawa)
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...
Areti Tillou24
Estimated H-index: 24
,
Malkeet Gupta8
Estimated H-index: 8
+ 4 AuthorsHenry Cryer19
Estimated H-index: 19
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
Rene Ramirez5
Estimated H-index: 5
,
Elizabeth L. Cureton11
Estimated H-index: 11
+ 6 AuthorsGregory P. Victorino20
Estimated H-index: 20
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 ...
Published on May 1, 2009in American Journal of Emergency Medicine1.65
Tyler W. Barrett17
Estimated H-index: 17
(VUMC: Vanderbilt University Medical Center),
Michelle Schierling1
Estimated H-index: 1
(VUMC: Vanderbilt University Medical Center)
+ 5 AuthorsKeith Wrenn9
Estimated H-index: 9
(VUMC: Vanderbilt University Medical Center)
Abstract Study Objective The primary intention of spiral computed tomography (SCT) in trauma patients is to identify significant injuries. However, unanticipated information is often discovered. We hypothesize that SCT often identifies clinically significant incidental findings in trauma patients. Methods This was a retrospective protocol chart review of consecutive adult trauma patients seen at a level I trauma center. A complete SCT was defined as computed tomography imaging of the head, cervi...
Published on Apr 1, 2009in The Lancet59.10
Stefan Huber-Wagner16
Estimated H-index: 16
(LMU: Ludwig Maximilian University of Munich),
Rolf Lefering52
Estimated H-index: 52
+ 6 AuthorsKarl-Georg Kanz25
Estimated H-index: 25
(LMU: Ludwig Maximilian University of Munich)
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...
Jaap Deunk11
Estimated H-index: 11
,
Monique Brink11
Estimated H-index: 11
+ 5 AuthorsMichael J. R. Edwards9
Estimated H-index: 9
BACKGROUND: Discussion still remains whether computed tomography (CT) of the abdomen, pelvis, and lumbar spine should be performed routinely after blunt trauma with high energy impact or only in restricted situations. The purpose of this study was to evaluate the additional value of a routine CT algorithm as compared with a more restricted, selective CT algorithm. MATERIALS: This prospective study consisted of 465 patients that met the inclusion criteria of our high-energy trauma protocol. All p...
Published on Nov 1, 2008in Journal of Clinical Pathology2.35
P K Singh1
Estimated H-index: 1
,
H N Buch1
Estimated H-index: 1
Adrenal incidentalomas are adrenal masses discovered incidental to imaging studies performed for reasons unrelated to adrenal pathology. Although most adrenal incidentalomas are non-functioning benign adenomas, their increasing prevalence presents diagnostic and therapeutic challenges. The assessment of adrenal incidentalomas is aimed at deciding whether or not the tumour should be surgically removed. Adrenalectomy is indicated for phaeochromocytoma, other symptomatic hormone-secreting tumours a...
Cited By15
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 Sep 1, 2019in International Journal of Medical Informatics2.73
Gaurav Trivedi2
Estimated H-index: 2
(University of Pittsburgh),
Charmgil Hong5
Estimated H-index: 5
(University of Pittsburgh)
+ 3 AuthorsShyam Visweswaran17
Estimated H-index: 17
(University of Pittsburgh)
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...
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 Nov 1, 2017in Surgery3.48
Nicholas Sich , Andrew P. Rogers4
Estimated H-index: 4
+ 8 AuthorsOrlando C. Kirton20
Estimated H-index: 20
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.
Published on Aug 1, 2017in Emergency Radiology
Melissa K. James2
Estimated H-index: 2
,
Michael P. Francois2
Estimated H-index: 2
(Ross University)
+ 2 AuthorsShi-Wen Lee2
Estimated H-index: 2
Purpose 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 fi...
Published on Jul 1, 2016in Canadian Family Physician2.19
Scott J. Adams2
Estimated H-index: 2
,
Paul Babyn15
Estimated H-index: 15
,
Alanna Danilkewich2
Estimated H-index: 2
Le recours accru a l’imagerie transversale, de meme que l’amelioration de la qualite de l’image et de la resolution spatiale ont engendre une augmentation des detections fortuites (DF) dans les rapports de radiologie. Les detections fortuites, qui designent les constatations sans lien
Published on Jul 1, 2016in Canadian Family Physician2.19
Scott J. Adams2
Estimated H-index: 2
(U of S: University of Saskatchewan),
Paul Babyn15
Estimated H-index: 15
(U of S: University of Saskatchewan),
Alanna Danilkewich2
Estimated H-index: 2
(U of S: University of Saskatchewan)
Increased use of cross-sectional imaging along with improved image quality and increased spatial resolution has led to an increase in the number of incidental findings (IFs) in radiology reports. Incidental findings , defined as findings that are unrelated to the clinical indication for the imaging
Published on Jan 1, 2016
Leonard Berlin1
Estimated H-index: 1
(UIUC: University of Illinois at Urbana–Champaign)
With the advent of high resolution CT, MRI, and ultrasound scanning, the frequency of radiologists’ serendipitous discovery of incidental findings (colloquially referred to as “incidentalomas”) on radiological examinations is increasing. Incidentalomas account for approximately 20% of all findings, due to two reasons: (a) the number of hi-tech imaging exams (primarily CT) performed today, and (b) the increasing sophistication of the technology. In the early 1980s when CT scanning was in its infa...
Published on Dec 1, 2015in Journal of Trauma Management & Outcomes
Courtney E. Collins6
Estimated H-index: 6
(UMMS: University of Massachusetts Medical School),
Nicole Cherng2
Estimated H-index: 2
(UMMS: University of Massachusetts Medical School)
+ 5 AuthorsJon D. Dorfman5
Estimated H-index: 5
(UMMS: University of Massachusetts Medical School)
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.
Published on Dec 1, 2014in Patient Safety in Surgery
Johannes Fakler7
Estimated H-index: 7
,
Orkun Özkurtul3
Estimated H-index: 3
,
Christoph Josten26
Estimated H-index: 26
Background Whole-body Computed Tomography (CT) scan today is considered a crucial imaging technique in the diagnostic work-up of polytrauma patients implicating a potential survival benefit. Apart from prompt identification of life threatening injuries this imaging technique provides an additional benefit by diagnosing incidental non-trauma associated medical diseases. These incidental findings might be also life threatening and warrant urgent therapy. The downside of whole-body CT is a relative...
View next paperFrequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center.