Prevalence of incidental findings in trauma patients detected by computed tomographyimaging
Barrett TW, Schierling M, Zhou C,
American Journal of Emergency Medicine 2009; 27: 428–435
Vanderbilt University Medical Center, Nashville, TN, USA
There is an increasing trend in the use of spiral CT scanning in the management of traumapatients. Although the primary intention of the CT is to identify injuries, unanticipated informationis often discovered in the course of this testing. Incidental findings, sometimes of a seriousnature and unrelated to the trauma, impose additional demands on the decision-making process.
“...A significant number of trauma patients evaluated withspiral CT are diagnosed with potentially serious incidental findings. For long-term care and medicolegal concerns, physicians need to inform patients of these incidental findings and the need for further evaluation.”
Incidental findings on spiral CT for trauma
Type 1 findingsType 2 findings
Number990 (32%)1274 (41.2%)
Total number of findings reported26621885At least one incidental finding(either type)1635 (53%)Suggesting neoplasms631-Included 196 pulmonary nodules, 99 liver masses, 36 renal masses, 23 brainmasses, and 11 breast masses
type 1 findings
- potentially serious results that necessitate furtherevaluation and close follow-up
type 2 findings
- requiring informing the patient but do not mandate urgentfollow-up.
The commendable element of this study is the efforts that the authors have taken to minimize measurement (observer) biasin chart review: the pivotal aspect of the data extraction process in this observational study. They also freely admit to thelimitations of the study. They have no idea what happened to the patients on follow up, nor do they have any data of thenumber of patients who knew about the existence of these conditions that were detected on the CT. Admittedly, the figurethat they highlight is very large and evokes serious concerns about recommendations for the widespread use of spiral CT inseriously injured patients. Having ordered a test, it is the responsibility of the physician to inform the patient about findingsand to act on them. Trauma is one specific situation when patients can "fall between the cracks" with respect to continuity of care and fail to undergo further investigation of the lesions detected.
The devil is in the details (more on the paper) ...
Dr Arjun Rajagopalan
Evidence levelOverall ratingBias levels
Double blind RCT
Life's tooshort for this
Full of holes
“Just do it”SamplingRandomized controlled trial (RCT)ComparisonProspective cohort study - not randomizedMeasurementCase controlled study
Case series - retrospective
Major, adult trauma patients seenat a Level I, urban trauma centrein the United States over a 12month period (Nov 2005 - Oct2006).
"Complete" spiral CT scan (SCT).
The pattern of unexpectedfindings, not related to trauma,seen on SCT that potentially couldpose danger to the patient'spresent or future health.
16 May 2009
Evidence-based Medicine for Surgeons