Optimal management strategy for incidental findings in trauma patients: an initiative for midlevel providers

J Trauma. 2008 Aug;65(2):331-4; discussion 335-6. doi: 10.1097/TA.0b013e31817e5153.


Background: Increasing patient volume and residents' work hour restrictions have increased the workload at trauma centers. Further, comprehensive tertiary surveys after initial stabilization and appropriate follow-up plans for incidental findings are time consuming. Midlevel providers (MLP) can help streamline this process. We initiated a care plan in which MLPs conducted all tertiary surveys and coordinated follow-ups for incidental findings.

Methods: From November 2005 through May 2006, we implemented a MLP-driven initiative aimed at performing tertiary surveys within 48 hours of admission on all trauma patients admitted to our Level-1 trauma center. Tertiary surveys consisted of a complete history and physical, radiographic evaluations and appropriate consultations. Incidental findings were recorded and communicated to the trauma attending. A follow-up plan was devised, and the course of action was documented. Patients or family members were informed, and their acknowledgments were filed. Data are presented as mean +/- SE.

Results: There were 1,027 patients admitted during the study period. Blunt mechanisms accounted for 81% of the injuries (primarily motor vehicle crashes and falls). Seventy-six patients had 87 incidental findings (7.4%); 53 were men. The mean age was 51.8 years +/- 2.1 years and mean injury severity score was 18.5 +/- 1.4. Incidental findings of clinical significance included 18 pulmonary nodules or neoplasms, 9 adrenal masses (>4 mm), 7 patients with lymphadenopathy, 5 benign cystic lesions, and 3 renal masses. Other neoplastic lesions included bladder (2), thyroid (2), ovary (1), breast (1), and rectum (1).

Conclusions: With prevalent medicolegal pressure and restricted residents' work hours, a MLP-initiative to streamline the tertiary survey effectively addresses incidental findings. This MLP-driven care plan can help reduce residents' workload, provides appropriate follow-up, and minimizes legal risks inherent to incidental findings on the trauma service.

MeSH terms

  • Adrenal Gland Diseases / epidemiology
  • Adult
  • Comorbidity
  • Continuity of Patient Care
  • Female
  • Humans
  • Incidental Findings*
  • Injury Severity Score
  • Lung Diseases / epidemiology
  • Male
  • Middle Aged
  • Neoplasms / epidemiology
  • North Carolina
  • Nurse's Role*
  • Prospective Studies
  • Trauma Centers / organization & administration*
  • Wounds and Injuries / epidemiology*