The prevalence and implications of incidental findings on ED abdominal CT scans

Published on Oct 1, 2001in American Journal of Emergency Medicine1.651
· DOI :10.1053/ajem.2001.27137
Wells A. Messersmith43
Estimated H-index: 43
David F.M. Brown40
Estimated H-index: 40
(Harvard University),
Michael J. Barry1
Estimated H-index: 1
Abstract We reviewed reports from 321 consecutive emergency department (ED) noncontrast, helical “renal stone” abdominal CT scans obtained at a single medical center between April 1996 to June 1997 for incidental findings. Incidental findings were common (45% of scans), and approximately half were rated of “moderate” or “serious” concern by 2 independent reviewers (kappa = 0.72). ED records indicated that only 21% of incidental findings were documented, and only 11 (18%) of cases with findings of “moderate/severe” concern had evidence of follow-up on hospital chart review. Although work-up of these 11 cases did not yield any serious diagnoses, many potentially serious incidental findings without follow-up remain worrisome. (Am J Emerg Med 2001;19:479-481. Copyright © 2001 by W.B. Saunders Company)
  • References (56)
  • Citations (84)
📖 Papers frequently viewed together
78 Citations
64 Citations
50 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Vladimir Brik (UW: University of Wisconsin-Madison)H-Index: 7
#2Eric J. Rozner (UW: University of Wisconsin-Madison)H-Index: 17
Last. Paramvir Bahl (Microsoft)H-Index: 54
view all 4 authors...
The continually increasing number of wireless devices operating in the unlicensed frequency bands makes the freely-available wireless spectrum a scarce commodity. Under such circumstances, efficient wireless spectrum management is necessary to minimize the effects of overcrowding and maximize quality of service. In this paper we present the design, implementation and evaluation of dynamic spectrum access protocol (DSAP), a centralized method for managing and coordinating spectrum access
256 CitationsSource
#1Manish Jain (Georgia Institute of Technology)H-Index: 12
#2Constantinos Dovrolis (Georgia Institute of Technology)H-Index: 25
The available bandwidth (avail-bw) in a network path is of major importance in congestion control, streaming applications, quality-of-service verification, server selection, and overlay networks. We describe an end-to-end methodology, called self-loading periodic streams (SLoPS), for measuring avail-bw. The basic idea in SLoPS is that the one-way delays of a periodic packet stream show an increasing trend when the stream's rate is higher than the avail-bw. We have implemented SLoPS in a tool cal...
907 CitationsSource
#1Anirban Mahanti (U of S: University of Saskatchewan)H-Index: 29
#2Derek L. Eager (U of S: University of Saskatchewan)H-Index: 36
Last. David Sundaram-Stukel (UW: University of Wisconsin-Madison)H-Index: 5
view all 4 authors...
Previous scalable on-demand streaming protocols do not allow clients to recover from packet loss. This paper develops new protocols that: (1) have a tunably short latency for the client to begin playing the media; (2) allow heterogeneous clients to recover lost packets without jitter as long as each client's cumulative loss rate is within a tunable threshold; and (3) assume a tunable upper bound on the transmission rate to each client that can be as small as a fraction (e.g., 25%) greater than t...
114 CitationsSource
#1Nachiappan Nagappan (NCSU: North Carolina State University)H-Index: 43
#2Laurie Williams (NCSU: North Carolina State University)H-Index: 51
Last. Suzanne Balik (NCSU: North Carolina State University)H-Index: 6
view all 7 authors...
Pair programming is a practice in which two programmers work collaboratively at one computer, on the same design, algorithm, or code. Prior research indicates that pair programmers produce higher quality code in essentially half the time taken by solo programmers. An experiment was run to assess the efficacy of pair programming in an introductory Computer Science course. Student pair programmers were more self-sufficient, generally perform better on projects and exams, and were more likely to co...
235 CitationsSource
Dec 9, 2002 in OSDI (Operating Systems Design and Implementation)
#1Brian White (UofU: University of Utah)H-Index: 4
#2Jay Lepreau (UofU: University of Utah)H-Index: 26
Last. Abhijeet Joglekar (UofU: University of Utah)H-Index: 3
view all 9 authors...
Three experimental environments traditionally support network and distributed systems research: network emulators, network simulators, and live networks. The continued use of multiple approaches highlights both the value and inadequacy of each. Netbed, a descendant of Emulab, provides an experimentation facility that integrates these approaches, allowing researchers to configure and access networks composed of emulated, simulated, and wide-area nodes and links. Netbed's primary goals are ease of...
1,221 CitationsSource
#1J. Gast (UW: University of Wisconsin-Madison)H-Index: 1
#2Paul Barford (UW: University of Wisconsin-Madison)H-Index: 41
Effective placement of resources used to support distributed services in the Internet depends on an accurate representation of Internet topology and routing. Representations of autonomous system (AS) level topology derived solely from BGP tables show only a subset of the connections that actually get used. However, in many cases, missing connections can be discovered by simple traceroutes. In addition, the differences between customer-to-provider links, peer-to-peer links, and sibling-to-sibling...
4 CitationsSource
#1Stuart StanifordH-Index: 15
#2James HoaglandH-Index: 8
Last. Joseph M. McalerneyH-Index: 3
view all 3 authors...
Portscan detectors in network intrusion detection products are easy to evade. They classify a portscan as more than N distinct probes within M seconds from a single source. This paper begins with an analysis of the scan detection problem, and then presents Spice (Stealthy Probing and Intrusion Correlation Engine), a portscan detector that is effective against stealthy scans yet operationally practical. Our design maintains records of event likelihood, from which we approximate the anomalousness ...
467 CitationsSource
Jan 1, 2002 in INFOCOM (International Conference on Computer Communications)
#1David J. Yates (UW: University of Wisconsin-Madison)H-Index: 39
#2Derek L. Eager (U of S: University of Saskatchewan)H-Index: 36
Last. Mary K. VernonH-Index: 38
view all 4 authors...
This paper develops simple cost models for provisioning content distribution networks that use the simple and highly scalable bandwidth skimming protocol for streaming. New insight is obtained into: (1) how cost-effective proxy servers are in multicast streaming systems; (2) the most effective streaming protocol; and (3) the optimal proxy content, as a function of the system configuration and workload. A key result is that proxy servers are only cost effective if: (a) the origin server does not ...
43 CitationsSource
Jun 3, 2002 in SIGMOD (International Conference on Management of Data)
#1Charles D. Cranor (AT&T Labs)H-Index: 13
#2Yuan Gao (AT&T Labs)H-Index: 1
Last. Oliver Spatscheck (AT&T Labs)H-Index: 29
view all 5 authors...
Operators of large networks and providers of network services need to monitor and analyze the network traffic flowing through their systems. Monitoring requirements range from the long term (e.g., monitoring link utilizations, computing traffic matrices) to the ad-hoc (e.g. detecting network intrusions, debugging performance problems). Many of the applications are complex (e.g., reconstruct TCP/IP sessions), query layer-7 data (find streaming media connections), operate over huge volumes of data...
116 CitationsSource
May 12, 2002 in S&P (IEEE Symposium on Security and Privacy)
#1Frédéric CuppensH-Index: 31
#2Alexandre MiègeH-Index: 8
This paper presents the work we have done within the MIRADOR project to design CRIM, a cooperative module for intrusion detection systems (IDS). This module implements functions to manage, cluster, merge and correlate alerts. The clustering and merging functions recognize alerts that correspond to the same occurrence of an attack and create a new alert that merge data contained in these various alerts. Experiments show that these functions significantly reduce the number of alerts. However, we a...
651 CitationsSource
Cited By84
#1Ohad Oren (Harvard University)
#2Robert A. Kyle (Harvard University)H-Index: 132
Last. David P. Steensma (Harvard University)H-Index: 50
view all 3 authors...
#1Adam Bernheim (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 7
#1Adam Bernheim (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 2
Last. David Sarkany (Staten Island University Hospital)H-Index: 3
view all 16 authors...
Rationale and Objectives To evaluate if incidental abdominopelvic calcified atherosclerosis (ACA) in patients under 50 years of age correlates with cardiovascular disease (CVD) risk factors. Most studies evaluating calcific atherosclerosis and associated increased risk of CVD have concentrated on middle age and older populations. Materials and Methods A retrospective review of 519 emergency department patients, aged 25–50 years, receiving computed tomography (CT) was performed and ACA correlated...
1 CitationsSource
#1Nathaniel Bell (USC: University of South Carolina)H-Index: 14
#2Amanda K. Arrington (UA: University of Arizona)H-Index: 12
Last. Jan M. Eberth (USC: University of South Carolina)H-Index: 14
view all 7 authors...
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...
#1Eduardo J. Mortani Barbosa (UPenn: University of Pennsylvania)H-Index: 3
#2Oladayo Osuntokun (UPenn: University of Pennsylvania)H-Index: 1
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.
#1Elizabeth K. Weidman (NewYork–Presbyterian Hospital)H-Index: 8
#2Michael L. Loftus (NewYork–Presbyterian Hospital)H-Index: 6
Inappropriate use of diagnostic imaging in the emergency department setting is a growing concern. Multiple factors drive imaging utilization in the ED, and diagnostic imaging use has increased dramatically in the past two decades. Medical radiation now accounts for the largest percent of artificial exposure to ionizing radiation in the USA, and while a direct link between radiation exposure from imaging and cancer development has not been proven, there is increasing concern about the potential h...
#1Gabriel BlecherH-Index: 5
#2Robert MeekH-Index: 11
Last. Philip McCahyH-Index: 4
view all 4 authors...
Background Patients presenting to the ED with suspected renal colic are frequently imaged with CT urography (CTU), which rarely alters diagnosis or management. To reduce use of CTU in this population, we instigated a new imaging and management guideline in our ED. Methods This was a quasi-experimental prospective study, whereby a new guideline was commenced at the intervention site (Monash Medical Centre) and the existing guideline continued at the control site (Dandenong Hospital). The new guid...
3 CitationsSource
#1Nicholas SichH-Index: 1
#2Andrew P. RogersH-Index: 4
Last. Ryan ShadisH-Index: 1
view all 11 authors...
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...
1 CitationsSource
#1Brit Long (San Antonio Military Medical Center)H-Index: 12
#2Michael D. April (San Antonio Military Medical Center)H-Index: 8
Last. Alex Koyfman (UTSW: University of Texas Southwestern Medical Center)H-Index: 13
view all 4 authors...
Abstract Background Trauma patients often present with injuries requiring resuscitation and further evaluation. Many providers advocate for whole body computed tomography (WBCT) for rapid and comprehensive diagnosis of life-threatening injuries. Objective Evaluate the literature concerning mortality effect, emergency department (ED) length of stay, radiation, and incidental findings associated with WBCT. Discussion Physicians have historically relied upon history and physical examination to diag...
9 CitationsSource
#1K. Treskes (AMC: Academic Medical Center)H-Index: 3
#2S. A. Bos (AMC: Academic Medical Center)H-Index: 1
Last. J. C. Goslings (AMC: Academic Medical Center)H-Index: 6
view all 12 authors...
Objectives 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.
9 CitationsSource
#1Matthew E. Zygmont (Emory University)H-Index: 6
#2Haris Shekhani (Emory University)H-Index: 6
Last. Tarek N. Hanna (Emory University)H-Index: 11
view all 5 authors...
Abstract Purpose The aim of this study was to assess the efficacy of an educational framework encouraging the systematic application of national societal recommendations regarding the imaging evaluation and follow-up of incidental findings (IFs) in the emergency department. Methods After institutional review board approval was received, consecutive CT and ultrasonographic examinations from the emergency department over a 2-month period were collected. Examination reports were categorized by stud...
2 CitationsSource