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European Radiology

, Volume 29, Issue 12, pp 6772–6779 | Cite as

Incidental findings in thoracic CTs performed in trauma patients: an underestimated problem

  • Eduardo J. Mortani BarbosaJrEmail author
  • Oladayo Osuntokun
Emergency Radiology
  • 91 Downloads

Abstract

Objectives

Whole-body CT scans are commonly performed to assess trauma patients, and often reveal incidental findings (IFs) the patient may be unaware of. We assessed the prevalence, associations, and adequacy of follow-up of IFs.

Methods

We retrospectively identified 1113 patients who had a chest CT to assess for traumatic injuries (6-year interval). We coded the radiology reports for IFs and queried our EMR regarding clinical history and adherence to follow-up recommendations for IFs mentioned in the reports.

Results

IFs are much more likely (62.2%) to be found in a chest CT scan than acute traumatic injuries (ATI, 32.4%), in patients being evaluated for potential traumatic injuries. A total of 86.4% of patients who had IFs also had another relevant ICD-10 diagnosis (RD). Lung nodules were the most common IF (45.7%). A multivariate logistic regression model (MLR) demonstrated an accuracy of 89% to predict IFs; the 3 statistically significant predictors (p < 0.05) were any RD (FDR logworth 68.6), followed by smoking history (29.8) and age (4.1). Radiologists recommended follow-up for IF 53.5% of the time, but only 13.9% of patients ever received a follow-up imaging exam or invasive procedure.

Conclusions

IFs are much more common than ATI and can be accurately predicted based on MLR utilizing only 3 clinical variables. While radiologists often recommend follow-up for IFs in trauma patients, most are never effectively followed up or addressed, leading to increased risk of poor outcomes. Clinicians should be aware of the high prevalence of IFs and develop systems for appropriate, evidence-based recommendations, and effective management.

Key Points

• Incidental findings (IFs) are much more common (2×) than acute traumatic injuries (ATI) in chest CTs performed in trauma patients.

• IFs can be accurately predicted via logistic regression modeling with only 3 variables (any relevant ICD-10 diagnosis; positive smoking history; age), which may help radiologist to focus their attention on higher risk patients.

• Radiologists recommend follow-up for IFs more than half of the time; however, IFs are seldom followed up appropriately (less than 14%), leading to missed opportunities and potentially poor patient outcomes.

Keywords

Incidental findings Tomography Trauma center Patient compliance 

Abbreviations

ATI

Acute traumatic injuries

EMR

Electronic medical record

F/Up

Follow-up

HIPAA

Health Insurance Portability and Accountability Act

ICD-10

International Classification of Diseases, 10th edition

IFs

Incidental findings

IRB

Institutional Review Board

MLR

Multivariate logistic regression

NIH

National Institutes of Health

NPV

Negative predictive value

PPV

Positive predictive value

RD

Relevant diagnosis

WBCT

Whole-body CT

Notes

Acknowledgments

This research has been accepted as an oral scientific presentation and presented at the prestigious European Congress of Radiology 2019 (Vienna, Feb 27–Mar 3), control # 5176, SS 717, Feb 28 2019.

Funding

This study has received funding by the National Heart, Lung and Blood Institute, National Institutes of Health, through grant R25-HL084665 (Oladayo Osuntokun). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Eduardo J. Mortani Barbosa Jr., MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (EB) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Eduardo J. Mortani BarbosaJr
    • 1
    Email author
  • Oladayo Osuntokun
    • 1
  1. 1.Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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