Prevalence of incidental findings on CT scans performed on trauma patients: What are we missing?

Abstract

IntroductionA growing number of potentially clinically significant (PCS) incidental findings are being identified for trauma patients in their computed tomography (CT) imaging, but it is unclear how prevalent these significant, nontraumatic findings are or how well they are communicated to patients or providers for follow-up. This study examines the prevalence of PCS findings in trauma patients presenting to an urban Emergency Department and evaluates their medical record and discharge papers for evidence of communication regarding the finding(s). MethodsBetween April and October 2019, a total of 300 consecutive trauma patients undergoing CT scans at a level-1 trauma center were retrospectively analyzed for nontraumatic PCS findings documented in the radiologist report. All PCS findings were grouped by type or organ. Discharge papers and medical record of patients with PCS findings were also reviewed to determine the level of communication regarding significant findings. ResultsOf the 300 patients in the study (230 male), 78 (26.3%) were identified as having 83 distinct PCS findings, with the greatest number (17/83, 21.7%) falling in the atherosclerosis or ‘Other vascular’ category. Gallbladder pathologies (12/83, 14.5%) were next most common, with cysts or masses on various organs (36/83, 43.4%) collectively comprising the majority of remaining findings. At least 2.4% of findings (2/83) were life-threatening and necessitated urgent treatment. There was little evidence in the discharge papers or electronic medical record that PCS findings had been communicated to patients or otherwise. ConclusionsPCS nontraumatic, incidental findings are prevalent in trauma patients, yet there is little evidence of how often or how well this crucial information is communicated to patients. Assigning protocols for reporting PCS findings in-person and creating systematic reporting options in the medical record can ensure that patients receive potentially life-saving health information.