Relevante Zufallsbefunde und iatrogene Verletzungen

Zusammenfassung

Hintergrund

Im Rahmen der Schnittbildgebung zufällig erhobene Befunde sind ein bereits häufiger an verschiedenen Patientenkollektiven beschriebenes Phänomen. Ziel der vorliegenden Arbeit ist die Evaluation der Relevanz von Zufallsbefunden und iatrogen verursachten Befunden bei Patienten, die über den Schockraum (SR) aufgenommen wurden und in diesem Rahmen ein Ganzkörper-CT erhalten haben.

Methode

Eingeschlossen wurden alle Patienten, die im Zeitraum vom 01.02.2012 bis zum 31.01.2014 über den SR der Zentralen Notaufnahme (ZNA) der Universitätsmedizin Mannheim aufgenommen wurden. Es erfolgten eine retrospektive Erhebung aller im Rahmen der CT-Bildgebung erhobenen Zufallsbefunde und eine Klassifizierung nach Relevanz. Darüber hinaus wurden alle iatrogenen Verletzungen und Tubus- bzw. Katheterfehllagen erfasst.

Ergebnisse

Bei den 1165 eingeschlossenen traumatologischen und internistisch-neurologischen SR-Patienten, welche ein Ganzkörper-CT im Rahmen der SR-Versorgung erhalten hatten, kamen insgesamt 465 Zufallsbefunde zur Darstellung, von denen 72 Befunde (15,5 % der Zufallsbefunde) in der CT-Diagnostik in Zusammenschau mit der klinischen Präsentation als klinisch relevant eingestuft wurden. Insgesamt zeigten damit 5,8 % der Patienten (68/1165) relevante Zufallsbefunde. Des Weiteren zeigten sich bei 3,7 % der Patienten (43/1165) Befunde, die als iatrogen verursacht gewertet wurden.

Schlussfolgerung

Zusätzlich zu den diagnostizierten Hauptbefunden fanden sich in der Ganzkörper-CT bei fast 10 % (9,5 %) der Patienten klinisch relevante Zufallsbefunde und iatrogen verursachte Befunde.

Abstract

Background

Whole-body computed tomography (CT) is increasingly being used as the diagnostic modality of choice in patients admitted to the resuscitation room. Beyond findings related to the suspected diagnosis it often additionally reveals incidental findings. The aim of this investigation was the evaluation of these findings in patients admitted via the emergency room after suffering potential major trauma or life-threatening medical conditions. Furthermore, the number of iatrogenic injuries as well as misplaced catheters and endotracheal tubes was investigated.

Methods

All patients admitted from 1 February 2012 to 31 January 2014 via the resuscitation area of the Mannheim University Medical Center, a tertiary care hospital and level 1 trauma center, were included in this study if they had undergone a whole-body CT scan at admission. Data from 1362 patients were collected retrospectively and 197 patients were excluded because of missing data so that the final cohort consisted of 1165 patients (1038 trauma and 127 internal neurological patients). Reports from the whole-body CT scans were screened for incidental findings. These findings were then classified as either clinically relevant or not. Furthermore, the reports were checked for iatrogenic injuries as well as misplaced catheters and endotracheal tubes.

Results

A total of 465 incidental findings were reported in 293 patients (25.1%) of the final cohort. In the synopsis of the radiological and clinical findings, 72 were rated as clinically relevant. In one patient two relevant incidental findings were reported and one patient presented with three incidental findings. In total, relevant incidental findings could be detected in 5.8% of the study patients (68/1165). In the discharge letters and/or the radiological report 16.2% of the incidental findings rated as clinically relevant were reported to be previously known, 66.2% were reported to be unknown and 17.6% could not be unequivocally classified as known or unknown due to missing references in the discharge letters. The group of internal neurological patients were clearly older than the trauma patients (61.6 years vs. 45.5 years). The rate of relevant incidental findings in the internal neurological group was more than twice as high as in the trauma group (11.0% vs. 5.2%); however, in the relatively young trauma group 1 in 20 patients showed an incidental finding classified as clinically relevant. In 43 (3.7%) patients a total of 46 iatrogenic injuries or misplaced catheters were reported. The most common finding was a too deeply placed endotracheal tube and five transurethral catheters placed in the emergency room were found to be blocked within the urethra.

Conclusion

In addition to the main diagnosis, clinically relevant incidental findings were reported in nearly 25% of whole-body CT scans of patients admitted to the resuscitation room. Approximately 6% of patients had incidental findings rated as clinically relevant. In the internal neurological group of patients the rate of incidental findings was doubled compared to the trauma group; however, the latter were significantly younger. Whole-body CT was also useful for diagnosing iatrogenic injuries and misplaced catheters in approximately 4% of the study patients.