378 Prevalence and Follow-Up of Incidental Findings in Focused Assessment With Sonography for Trauma Examinations

Abstract

The focused assessment with sonography for trauma (FAST) is a commonly performed point-of-care ultrasound examination to evaluate trauma patients in the emergency department (ED). Incidental findings in imaging studies are a common occurrence with variable clinical significance. Failure to communicate these findings to patients can potentially lead to adverse outcomes and medico legal claims. To our knowledge, no prior study has been performed regarding the frequency and follow-up of incidental findings encountered by emergency physicians on FAST examinations. The objective of this study was to determine the frequency, documentation, and communication of incidental findings on emergency physician-performed FAST ultrasound examinations. This is a retrospective review of FAST examinations performed by emergency physicians for adult trauma patients in two academic EDs. FAST examinations used for medical decision making at the bedside were identified from ED ultrasound image archival system (Q-path). Emergency medicine residents and attending physicians with varied point-of-care ultrasound experience performed and interpreted FAST ultrasound examinations. All identified FAST examinations were reviewed by one of the study investigators for the presence of incidental findings. Additionally, an expert emergency sonologist reviewed all FAST examinations with incidental findings and 10% of FAST examinations with no incidental findings. The patients’ medical records were then reviewed for demographic information, mechanism of injury, type of incidental findings, documentation of incidental findings, and communication of incidental findings with the patient. Continuous variables were reported as means with standard deviations and categorical variables were reported as proportions. Inter-rater reliability was assessed using the kappa test statistic. A total of 1452 FAST examinations were reviewed over a 15-month period. One hundred and thirty-seven patients with incidental findings were identified (9.4%); 7 patients had more than one incidental finding. Inter-rater reliability among reviewers was very high (92%). The mean age of patients (78 females, 59 males) with incidental findings was 52 (SD 23); without, 44 (SD 19, p<.001). Motor vehicle collision was the most common mechanism of injury, followed by falls. Renal pathology (cysts and hydronephrosis) was the most common finding (57/137, 41.6%), followed by pelvic cysts in women (40/137, 29.1%). While 31/137 (22.6%) incidental findings were identified and documented in the ultrasound reports by ED providers, only 6/137 (4.4%) patients were informed of their incidental findings. Incidental findings are often encountered in FAST ultrasound examinations, most commonly in older, female patients. A vast majority of incidental findings were not documented and communicated to patients, which may have medico legal implications.