Abstract
BackgroundThe increasing use of computed tomography (CT) scans in the evaluation of trauma patients has led to increased detection of incidental radiologic findings. Incidental findings (IFs) of the abdominal viscera are among the most commonly discovered lesions and can carry a risk of malignancy. Despite this, patient notification regarding these findings is often inadequate.MethodsWe identified patients who underwent abdominopelvic CTs as part of their trauma evaluation during a recent 1-year period (9/2011-8/2012). Patients with IFs of the kidneys, liver, adrenal glands, pancreas and/or ovaries had their charts reviewed for documentation of the lesion in their discharge paperwork or follow-up. A quality improvement project was initiated where patients with abdominal IFs were verbally informed of the finding, it was noted on their discharge summary and/or were referred to specialists for evaluation. Nine months after the implementation of the IF protocol, a second chart review was performed to determine if the rate of patient notification improved.ResultsOf 1,117 trauma patients undergoing abdominopelvic CT scans during the 21 month study period, 239 patients (21.4%) had 292 incidental abdominal findings. Renal lesions were the most common (146 patients, 13% of all patients) followed by hepatic (95/8.4%) and adrenal (38/3.4%) lesions. Pancreatic (10/0.9%) and ovarian lesions (3/0.3%) were uncommon. Post-IF protocol implementation patient notification regarding IFs improved by over 80% (32.4% vs. 17.7% pre-protocol, p = 0.02).ConclusionIFs of the solid abdominal organs are common in trauma patients undergoing abdominopelvic CT scan. Patient notification regarding these lesions is often inadequate. A systematic approach to the documentation and evaluation of incidental radiologic findings can significantly improve the rate of patient notification.Electronic supplementary materialThe online version of this article (doi:10.1186/s13032-014-0022-x) contains supplementary material, which is available to authorized users.
Highlights
The increasing use of computed tomography (CT) scans in the evaluation of trauma patients has led to increased detection of incidental radiologic findings
The evaluation of trauma patients routinely involves the use of computed tomography (CT)
The high acuity and complexity of individual trauma patients who frequently present with multiple injuries and have multiple medical and surgical services involved in their care leads to prioritization of life-threatening and acute injuries first
Summary
The increasing use of computed tomography (CT) scans in the evaluation of trauma patients has led to increased detection of incidental radiologic findings. Solid abdominal organ IFs present a difficult dilemma for clinicians who must carefully balance the benefit of subsequent workup with the risks and costs of additional tests and procedures. Management of these newly diagnosed solid organ lesions in trauma patients is complex. The little data that does exist have shown low rates of patient notification and low rates of follow-up regarding these findings even in the case of potentially serious discoveries [5,7,9,10,11] This is especially concerning since trauma patients, like many Americans, may lack access to routine outpatient healthcare and may not receive appropriate workup or education after hospital discharge. Finding a costeffective way to approach these findings is important for trauma surgeons but for any provider who encounters IFs as to minimize dangerous clinical and medico-legal consequences
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