Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

Abstract

PURPOSE Imaging may produce unexpected or incidental fi ndings with consequences for patients and ordering of future investigations. Chest radiography in patients with acute cough is among the most common reasons for imaging in primary care, but data on associated incidental fi ndings are lacking. We set out to describe the type and prevalence of incidental chest radiography fi ndings in primary care patients with acute cough. METHODSWe report on data from a cross-sectional study in 16 European primary care networks on 3,105 patients with acute cough, all of whom were undergoing chest radiography as part of a research study workup. Apart from assessment for specifi ed signs of pneumonia and acute bronchitis, local radiologists were asked to evaluate any additional fi nding on the radiographs. For the 2,823 participants with good-quality chest radiographs, these fi ndings were categorized according to clinical relevance based on previous research evidence and analyzed for type and prevalence by network, sex, age, and smoking status. RESULTSIncidental fi ndings were reported in 19% of all participants, and ranged from 0% to 25% by primary care network, with the network being an independent contributor (P <.001). Of all participants 3% had clinically relevant incidental fi ndings. Suspected nodules and shadows were reported in 1.8%. Incidental fi ndings were more common is older participants and smokers (P <.001).CONCLUSIONS Clinically relevant incidental fi ndings on chest radiographs in primary care adult patients with acute cough are uncommon, and prevalence varies by setting. Ann Fam Med 2012;10:510-515. doi:10.1370/afm.1384. INTRODUCTIONA cute cough is one of the most common reasons for consulting in primary care. 1,2 Prompt, accurate diagnosis of pneumonia in these patients is important to rule in the need for timely appropriate antibiotic treatment in some patients and to rule out the need for antibiotic treatment in others. Responsible general practitioners order chest radiographs in a minority of patients with acute cough. 3 These radiographs confi rm pneumonia in 5% to 19% and exclude pneumonia in most patients. 2,4,5 Imaging provides information relevant to the acute illness but may also reveal incidental fi ndings. 6-9 Such fi ndings can benefi t patients through earlier diagnosis and treatment, for example, in as yet undiagnosed heart failure or malignancy. Incidental fi ndings, however, may have unknown or doubtful clinical relevance and lead to patient anxiety, expensive workup, and potentially harmful investigations and treatment without improving quality and length of life. 10,11 The nature and prevalence of incidental fi ndings on chest radiographs of patients who consult their general practitioner for acute cough is unknown. Such data may inform decisions about clinical indications for ordering chest radiographs. We studied incidental fi ndings on chest radiographs obtained METHODSWe undertook a cross-sectional observational study using data from the GRACE-09/10a study (Genomics to comba...

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“…Another multi-center study in Europe assessed the rate of incidental ndings in patients (mean age 50-years-old, 40% male) undergoing chest radiographs for acute cough. They report a rate of "clinically relevant" ndings (comparable to our Major and Moderate ndings) of 3.1% (we report 4.8%) and report a rate of nodules, densities, and shadows of 1.8% [32]. Our nodule rate (including granulomas) was 2.2% but excluding granulomas is 0.99%.…”

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Management of Incidental Findings in Clinical Genomic Sequencing

“…Incidental findings are not new to medicine and parallel medical situations may offer useful insights. For example, there is an extensive literature of incidental findings in radiology (Ahmed et al., ; Alpert and Naidich, ; van Vugt et al., ). One study reviewing whole‐body CT scans found an incidental finding rate of 86% (Furtado et al., ), and review and analysis of 44 publications on incidental findings suggested that the overall frequency of incidental findings in radiological studies was 23.6% (Lumbreras et al., ).…”