Eduardo J Mortani Barbosa1, Oladayo Osuntokun2. 1. Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Ground Floor Founders Bldg., Philadelphia, PA, 19104, USA. eduardo.barbosa@uphs.upenn.edu. 2. Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Ground Floor Founders Bldg., Philadelphia, PA, 19104, USA.
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.
OBJECTIVES: Whole-body CT scans are commonly performed to assess traumapatients, 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 traumapatients, 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 traumapatients. • 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.
Entities:
Keywords:
Incidental findings; Patient compliance; Tomography; Trauma center
Authors: Steven J Baccei; Sneha A Chinai; Martin Reznek; Scott Henderson; Kevin Reynolds; D Eric Brush Journal: J Am Coll Radiol Date: 2018-01-03 Impact factor: 5.532
Authors: Nicholas Sich; Andrew Rogers; Danelle Bertozzi; Praveen Sabapathi; Waed Alswealmeen; Philip Lim; Jonathan Sternlieb; Laura Gartner; James Yuschak; Orlando Kirton; Ryan Shadis Journal: Surgery Date: 2017-11-24 Impact factor: 3.982
Authors: J C Sierink; T P Saltzherr; M J A M Russchen; S M M de Castro; L F M Beenen; N W L Schep; J C Goslings Journal: Injury Date: 2013-10-30 Impact factor: 2.586
Authors: Sandra Niedermeier; Rebecca Wania; Alina Lampart; Robert Stahl; Christoph Trumm; Christian Kammerlander; Wolfgang Böcker; Christian H Nickel; Roland Bingisser; Marco Armbruster; Vera Pedersen Journal: Diagnostics (Basel) Date: 2022-01-30
Authors: Kaij Treskes; Teun P Saltzherr; Michael J R Edwards; Benn J A Beuker; Esther M M Van Lieshout; Joachim Hohmann; Jan S K Luitse; Ludo F M Beenen; Markus W Hollmann; Marcel G W Dijkgraaf; J Carel Goslings Journal: Eur Radiol Date: 2020-01-23 Impact factor: 5.315