Incidental Findings - Pan-Scan Unintended Consequences

Short Attention Span Summary

Incidentalomata
Pan-scan CT for trauma is of questionable value. It may find stuff you weren't looking for to begin with, which is a problem. In this retrospective look at 2440 trauma patients at a level one center who had pan-scans, there were 5440 incidental findings. 8.4% needed immediate attention; about one-third needed follow up in 3-6 months. The rest were less urgent. 

Spoon Feed
One of the unintended consequences of pan-scanning is lots of incidental findings. Make sure you have a mechanism in place to follow these up. Case managers are worth their weight in gold to help with this.


Abstract

Emerg Med J. 2017 Jan 27. pii: emermed-2016-205722. doi: 10.1136/emermed-2016-205722. [Epub ahead of print]

Non-traumatic incidental findings in patients undergoing whole-body computed tomography at initial emergency admission.

Kroczek EK1,2, Wieners G1, Steffen I1, Lindner T3, Streitparth F1, Hamm B1, Maurer MH4,5.

Author information:

1Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany.

2Department for Diagnostic and Interventional Neuroradiology, University Medical Centre Göttingen, Göttingen, Germany.

3Department of Emergency Medicine, Charité - University Medicine Berlin, Berlin, Germany.

4Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany martin.maurer@insel.ch.

5Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Abstract

OBJECTIVE:

To evaluate the number, localisation and importance of non-traumatic incidental findings (IFs) in patients with suspected or obvious multiple trauma undergoing whole-body CT (WBCT) in a level-1 trauma centre.

METHODS:

Between January 2009 and December 2013, a total of 2440 patients with trauma undergoing WBCT at admission to a level-1 trauma centre of a university hospital were retrospectively analysed, through imaging IFs unrelated to trauma with the radiological reports. All IFs were grouped into four categories according to their clinical relevance. Category 1: urgent treatment or further clarification needed; category 2: further examination and follow-up within 3-6 months required; category 3: findings with no immediate consequences for the treatment of the patient but of potential relevance in the future; category 4: harmless findings.

RESULTS:

Altogether, 5440 IFs in 2440 patients (1735 male, 705 female; mean age 45.1 years) were documented. In 204 patients (8.4%) urgent category 1 findings were reported, 766 patients (31.4%) had category 2 findings, 1236 patients (50.7%) had category 3 findings and 1173 patients (48.1%) had category 4 findings. Most IFs were detected in the abdomen/pelvis (42.5%). 602 (24.7%) of the patients had no IFs.

CONCLUSIONS:

WBCT scans of unrelated trauma patients demonstrate a high rate of IF. A substantial percentage (8.4%) of patients had urgent category 1IFs and a high percentage (31.4%) had category 2 IFs requiring a follow-up. This high number of patients with polytrauma undergoing WBCT, having IFs of high relevance, poses a major challenge for the level-1 trauma centre in the acute and postacute management of these patients.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PMID: 28130347 [PubMed - as supplied by publisher]