588 Incidence and Clinical Significance of Incidental Findings in Major Trauma Patients

Abstract

Abstract Aim This study aimed to characterise and demonstrate the clinical importance of incidental findings (IF) for patients presenting to a Major Trauma Centre (MTC). Method A prospective review of 941 consecutive patients who were imaged and subsequently admitted to hospital as Major Trauma. IF unrelated to the trauma were analysed from radiological imaging reports and documented management was reviewed. Results 594 patients (63.1%) received a pan/trauma CT, 225 (23.9%) had isolated CT scans and 122 (13%) had X-Rays only. 365 (38.7%) patients had a total of 647 IF. Of these: 15 (2.3%) were suggestive of malignancy (e.g., colon mass, liver tumour). 41 (6.3%) represented acute pathology requiring urgent intervention (e.g., pulmonary embolism, consolidation). 148 (22.9%) represented likely benign pathology but required further investigation or routine follow-up (e.g., pulmonary nodules, pancreatic cysts). 443 (68.5%) represented benign or chronic pathology not requiring any specific follow-up (e.g., hiatus hernia, diverticular disease). The reporting radiologist advised further investigation or review in 61 (6.5%) cases. This was actioned and documented in 44 (72.1%) cases by the MTC clinician as part of the tertiary survey. 9 patients still lacked adequate documentation, 2 were transferred to a different hospital, 1 self-discharged and 5 were never reviewed by the major trauma team. Conclusion The common utilisation of pan/trauma CT scanning in Major Trauma identifies a high volume of IF. Over a quarter represented potentially clinically significant findings that require onward investigation. MTC should ensure they have appropriate systems to capture and document IF including actioning further investigation and follow up.