Non-traumatic incidental findings in patients undergoing whole-body computed tomography at initial emergency admission

Emerg Med J. 2017 Oct;34(10):643-646. doi: 10.1136/emermed-2016-205722. Epub 2017 Jan 27.

Abstract

Objective: To evaluate the number, localisation and importance of non-traumatic incidental findings (IFs) in patients with suspected or obvious multiple trauma undergoing whole-body CT (WBCT) in a level-1 trauma centre.

Methods: Between January 2009 and December 2013, a total of 2440 patients with trauma undergoing WBCT at admission to a level-1 trauma centre of a university hospital were retrospectively analysed, through imaging IFs unrelated to trauma with the radiological reports. All IFs were grouped into four categories according to their clinical relevance. Category 1: urgent treatment or further clarification needed; category 2: further examination and follow-up within 3-6 months required; category 3: findings with no immediate consequences for the treatment of the patient but of potential relevance in the future; category 4: harmless findings.

Results: Altogether, 5440 IFs in 2440 patients (1735 male, 705 female; mean age 45.1 years) were documented. In 204 patients (8.4%) urgent category 1 findings were reported, 766 patients (31.4%) had category 2 findings, 1236 patients (50.7%) had category 3 findings and 1173 patients (48.1%) had category 4 findings. Most IFs were detected in the abdomen/pelvis (42.5%). 602 (24.7%) of the patients had no IFs.

Conclusions: WBCT scans of unrelated trauma patients demonstrate a high rate of IF. A substantial percentage (8.4%) of patients had urgent category 1IFs and a high percentage (31.4%) had category 2 IFs requiring a follow-up. This high number of patients with polytrauma undergoing WBCT, having IFs of high relevance, poses a major challenge for the level-1 trauma centre in the acute and postacute management of these patients.

Keywords: CT/MRI; emergency department management; epidemiology; imaging; major incidents; major trauma management; non-traumatic problems.

MeSH terms

  • Adult
  • Aged
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Germany
  • Humans
  • Incidental Findings*
  • Male
  • Middle Aged
  • Multiple Trauma / diagnosis
  • Retrospective Studies
  • Tomography, X-Ray Computed / methods*
  • Whole Body Imaging*