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Prevalence of incidental findings in trauma patients detected by computed tomography imaging

Prevalence of incidental findings in trauma patients detected by computed tomography imaging

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Published by Arjun Rajagopalan
A significant number of trauma patients evaluated with spiral 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.
A significant number of trauma patients evaluated with spiral 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.

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Published by: Arjun Rajagopalan on May 21, 2009
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06/17/2009

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Prevalence of incidental findings in trauma patients detected by computed tomographyimaging
Authors:
Barrett TW, Schierling M, Zhou C,
 
et al
Journal:
American Journal of Emergency Medicine 2009; 27: 428–435
Centre:
Vanderbilt University Medical Center, Nashville, TN, USA
BACKGROUND
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.
Authors' claim(s):
“...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.” 
I
N
 
SUMMARY
 
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.
T
HE
T
ISSUE
EPORT
 
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
EBM-O-METER 
Evidence levelOverall ratingBias levels
Double blind RCT
Trash
Life's tooshort for this
Swisscheese
Full of holes
Safe
Holds water 
News-worthy
“Just do it”SamplingRandomized controlled trial (RCT)ComparisonProspective cohort study - not randomizedMeasurementCase controlled study
Interesting
l
|
Novel
 
l
|
Feasible
 
l
Ethical
 
l
|
Resource
 
saving
 
l
Case series - retrospective
RESEARCH QUESTION
Population
Major, adult trauma patients seenat a Level I, urban trauma centrein the United States over a 12month period (Nov 2005 - Oct2006).
Indicator variable
"Complete" spiral CT scan (SCT).
Outcome variable
The pattern of unexpectedfindings, not related to trauma,seen on SCT that potentially couldpose danger to the patient'spresent or future health.
Comparison
None.
O
BSERVATIONAL
16 May 2009
Dissections
issections
Evidence-based Medicine for Surgeons

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