Abstract
ObjectivesTo 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.MethodsTrauma patients from five trauma centres were randomized between April 2011 and January 2014 to TBCT imaging or STWU consisting of conventional imaging with selective CT scanning. Incidental findings were divided into three categories: 1) major finding, may cause mortality; 2) moderate finding, may cause morbidity; and 3) minor finding, hardly relevant. Generalized estimating equations were applied to assess differences in incidental findings.ResultsIn total, 1083 patients were enrolled, of which 541 patients (49.9 %) were randomized for TBCT and 542 patients (50.1 %) for STWU. Major findings were detected in 23 patients (4.3 %) in the TBCT group compared to 9 patients (1.7 %) in the STWU group (adjusted rate ratio 2.851; 95%CI 1.337–6.077; p < 0.007). Findings of moderate relevance were detected in 120 patients (22.2 %) in the TBCT group compared to 86 patients (15.9 %) in the STWU group (adjusted rate ratio 1.421; 95%CI 1.088–1.854; p < 0.010).ConclusionsCompared to selective CT scanning, more patients with clinically relevant incidental findings can be expected by TBCT scanning.Key points• Total-body CT scanning in trauma results in 1.5 times more incidental findings.• Evaluation by TBCT in trauma results in more patients with incidental findings.• In every category of clinical relevance, TBCT detects more incidental findings.
Highlights
Total-body computed tomography scanning (TBCT) is often used during the primary assessment of patients after severe trauma
Major findings were detected in 23 patients (4.3 %) in the TBCT group compared to 9 patients (1.7 %) in the standard work-up (STWU) group
Compared to selective CT scanning, more patients with clinically relevant incidental findings can be expected by TBCT scanning
Summary
Total-body computed tomography scanning (TBCT) is often used during the primary assessment of patients after severe trauma. Since TBCT has not been shown to reduce mortality in the general trauma population, indication setting is important and a subject of debate [3]. Another consideration when performing TBCT is the increase in non-trauma-related radiologic findings. These concomitant incidental findings should be prioritized with respect to potential life-threatening injuries, and may require additional follow-up and treatment. On the contrary, when clinical significance is absent, incidental findings could result in unnecessary investigations and concerns for the patient and extra health care costs
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