Incidental findings in thoracic CTs performed in trauma patients: an underestimated problem

Barbosa, Eduardo J. Mortani; Osuntokun, Oladayo

doi:10.1007/s00330-019-06313-6

Cited by 18 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some of these may have already been diagnosed and treated so that no additional effort and resource utilisation is expected. In our own experience and consistent with other authors [ 6 , 7 , 8 , 10 , 12 , 13 , 14 , 17 , 34 ], a lack of systematic documentation and communication of IFs is evident, demanding digital solutions and general guidelines about communication of IFs [ 22 ]. The median age of our retrospective study cohort was 82 years; as a result, this analysis of IFs has the oldest trauma population published so far.…”

Section: Discussionsupporting

confidence: 83%

“…An amount of 1% to 46.9% of IFs could have an impact on patients’ health and require urgent treatment or further examination [ 5 , 10 , 11 , 17 ]. Interestingly, in chest CT performed on trauma patients, IFs are much more common than ATI; known relevant diagnoses, histories of smoking, and age serve as predicting factors for IFs [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incidental CT Findings in the Elderly with Low-Energy Falls: Prevalence and Implications

et al. 2022

View full text Add to dashboard Cite

Background: Computed tomography (CT) is commonly used in trauma care, with increasing implementation during the emergency work-up of elderly patients with low-energy falls (LEF). The prevalence of incidental findings (IFs) resulting from CT imaging and requiring down-stream actions in this patient cohort is unknown. We have investigated the prevalence and urgency of IFs from emergency CT examinations in these patients. Methods: A total of 2871 patients with LEF and emergency CT examinations were consecutively included in this retrospective cohort study. The primary endpoint was the prevalence of IFs; the secondary endpoint was their urgency. Results: The median age was 82 years (64.2% were women). IFs were identified in 73.9% of patients, with an average of 1.6 IFs per patient. Of all IFs, 16.4% were classified as urgent or relevant, predominantly in the abdomen, chest and neck. Increasing age was associated with the prevalence of an IF (odds ratio: 1.053, 95% confidence interval: 1.042–1.064). Significantly more IFs were found in female patients (75.2% vs. 71.5%). Conclusion: IFs resulting from CT examinations of the elderly are frequent, but in more than 8 out of 10, they are harmless or currently asymptomatic. For the benefit of an accurate diagnosis of traumatic lesions, concerns about IFs with respect to disease burden, further work-up and resource utilisation might be disregarded.

show abstract

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Incidental CT Findings in the Elderly with Low-Energy Falls: Prevalence and Implications

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Findings of incidentaloma on routine CCT are more common than finding acute traumatic injury when initial chest x-ray is normal. 16 However, the outcome is unchanged as the majority (86%) either failed to follow up, or did not need additional tests, and therefore a CT contribution to immediate management is doubtful. 16,17 Increasing age carries with it a high incidence of finding an incidentaloma in the chest and so as the use of anticoagulant therapy and those patients should be taken into consideration when ordering a CCT.…”

Section: Discussionmentioning

confidence: 99%

“…16 However, the outcome is unchanged as the majority (86%) either failed to follow up, or did not need additional tests, and therefore a CT contribution to immediate management is doubtful. 16,17 Increasing age carries with it a high incidence of finding an incidentaloma in the chest and so as the use of anticoagulant therapy and those patients should be taken into consideration when ordering a CCT. The length of stay in our group 2 was high which reflects the effort and the time the physician needs to evaluate and consult different specialties to address the incidental findings.…”

Section: Discussionmentioning

confidence: 99%

Value of Thoracic CT in Blunt Trauma Patients With High Glasgow Coma Scale and Low Injury Severity Scale

Wasfie

Hardy

Naisan³

et al. 2023

The American Surgeon™

View full text Add to dashboard Cite

Objective To determine the value of ordering a routine chest CT (CCT) in patients with blunt trauma presenting to the emergency department with a high GCS and low ISS, we retrospectively collected patient data including CT scan results, when physical examination and initial chest X-ray were normal in the trauma bay area. Methods A retrospective data collection of 901 consecutive blunt trauma patients seen in the ED between 2017 and 2019 was analyzed. Data included physical examination, age, gender, current use of anticoagulation therapy, comorbid conditions, as well as the result of radiologic images, hospital length of stay, surgical intervention, and mortality. The patients were divided into two groups: group one (patients with negative physical examination; chest x-ray and CT) and group 2 (negative physical examination, positive or negative chest x-ray, and positive CT). Statistical analysis was performed using student’s t-test and chi-square test. Results Of the 901 patients there were 489 (54%) males and 412 (46%) females with a mean age of 56 years. There were 461 patients who had a physical examination, chest x-ray, abdominal and CCT done. Group one included 442 (96%) patients, with negative physical examination, negative chest X-ray and CT scan. In group 2, 19 (4%) patients who had positive CT and or chest x-ray. Both groups were similar in GCS and ISS. Of the 19 patients, sixteen patients had a positive CCT, and thirteen of those had a positive chest x-ray. In the three patients who had negative physical examination and chest x-ray, the CT findings included one with a nondisplaced 10th rib fracture and two patients with osteoporotic compression fractures of dorsal vertebrae. The rate of both chest x-ray and CCT being positive among a group of screened patients was 16% (3/19) and the rate of a negative chest x-ray but positive CT was 16% (3/19). The odds ratio between the two outcomes was one. Conclusion In blunt trauma patients presenting to the ED with a high GCS and low ISS score, when initial physical examination and chest x-ray are negative, routine CCT is of little value.

show abstract

“…The rate at which incidental findings occur depends on many factors, including the imaging modality, the primary task, and expertise. One review estimated that at least one incidental finding appeared in 24% of a mixed collection of radiologic cases (Lumbreras, Donat, & Hernández-Aguado, 2010 ; see also Mortani Barbosa & Osuntokun, 2019 ). An unambiguous estimate of the rate of incidental findings would require an unambiguous definition of what should count as such a finding.…”

Section: Introductionmentioning

confidence: 99%

Visual search errors are persistent in a laboratory analog of the incidental finding problem

2020

View full text Add to dashboard Cite

When radiologists search for a specific target (e.g., lung cancer), they are also asked to report any other clinically significant "incidental findings" (e.g., pneumonia). These incidental findings are missed at an undesirably high rate. In an effort to understand and reduce these errors, Wolfe et al. (Cognitive Research: Principles and Implications 2:35, 2017) developed "mixed hybrid search" as a model system for incidental findings. In this task, non-expert observers memorize six targets: half of these targets are specific images (analogous to the suspected diagnosis in the clinical task). The other half are broader, categorically defined targets, like "animals" or "cars" (analogous to the less wellspecified incidental findings). In subsequent search through displays for any instances of any of the targets, observers miss about one third of the categorical targets, mimicking the incidental finding problem. In the present paper, we attempted to reduce the number of errors in the mixed hybrid search task with the goal of finding methods that could be deployed in a clinical setting. In Experiments 1a and 1b, we reminded observers about the categorical targets by inserting non-search trials in which categorical targets were clearly marked. In Experiment 2, observers responded twice on each trial: once to confirm the presence or absence of the specific targets, and once to confirm the presence or absence of the categorical targets. In Experiment 3, observers were required to confirm the presence or absence of every target on every trial using a checklist procedure. Only Experiment 3 produced a marked decline in categorical target errors, but at the cost of a substantial increase in response time.

show abstract

Incidental findings in thoracic CTs performed in trauma patients: an underestimated problem

Cited by 18 publications

References 16 publications

Incidental CT Findings in the Elderly with Low-Energy Falls: Prevalence and Implications

Incidental CT Findings in the Elderly with Low-Energy Falls: Prevalence and Implications

Value of Thoracic CT in Blunt Trauma Patients With High Glasgow Coma Scale and Low Injury Severity Scale

Visual search errors are persistent in a laboratory analog of the incidental finding problem

Contact Info

Product

Resources

About