Incidental findings on total-body CT scans in trauma patients

Sierink, Joanne C.; Saltzherr, Teun Peter; Russchen, M.J.A.M.; Castro, S. M. M. de; Beenen, Ludo F. M.; Schep, Niels W. L.; Goslings, J. Carel

doi:10.1016/j.injury.2013.10.009

Cited by 74 publications

(63 citation statements)

References 23 publications

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“…Previous studies have reported the detection of incidental findings in 32 % to 43 % of trauma patients screened in trauma centres with selective CT scanning [4, 5], and studies on TBCT scanning have reported incidental findings in 45 % to 53 % of trauma patients [6–8]. However, direct comparisons of the frequency and relevance of incidental findings between TBCT and standard work-up with selective CT scanning in trauma patients are lacking.…”

Section: Introductionmentioning

confidence: 99%

High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial

et al. 2016

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ObjectivesTo determine whether there is a difference in frequency and clinical relevance of incidental findings detected by total-body computed tomography scanning (TBCT) compared to those by the standard work-up (STWU) with selective computed tomography (CT) scanning.MethodsTrauma patients from five trauma centres were randomized between April 2011 and January 2014 to TBCT imaging or STWU consisting of conventional imaging with selective CT scanning. Incidental findings were divided into three categories: 1) major finding, may cause mortality; 2) moderate finding, may cause morbidity; and 3) minor finding, hardly relevant. Generalized estimating equations were applied to assess differences in incidental findings.ResultsIn total, 1083 patients were enrolled, of which 541 patients (49.9 %) were randomized for TBCT and 542 patients (50.1 %) for STWU. Major findings were detected in 23 patients (4.3 %) in the TBCT group compared to 9 patients (1.7 %) in the STWU group (adjusted rate ratio 2.851; 95%CI 1.337–6.077; p < 0.007). Findings of moderate relevance were detected in 120 patients (22.2 %) in the TBCT group compared to 86 patients (15.9 %) in the STWU group (adjusted rate ratio 1.421; 95%CI 1.088–1.854; p < 0.010).ConclusionsCompared to selective CT scanning, more patients with clinically relevant incidental findings can be expected by TBCT scanning.Key points• Total-body CT scanning in trauma results in 1.5 times more incidental findings.• Evaluation by TBCT in trauma results in more patients with incidental findings.• In every category of clinical relevance, TBCT detects more incidental findings.

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Section: Introductionmentioning

confidence: 99%

High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial

et al. 2016

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“…[17][18][19][20][21][22][23][24] Incidental findings in the chest or abdomen are found in 14% to 50% of patients 23 25 and 29% to 94% of volunteers, 26 27 particularly with cardiac and colon imaging. [28][29][30] Physiological anomalies and artefacts may be misidentified as disease by researchers without specialist medical training.…”

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confidence: 99%

Acting on incidental findings in research imaging

Wardlaw

Davies²,

Booth³

et al. 2015

BMJ

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“…75 The impact of WBCT in the ED on the rate of incidentaloma detection has not been extensively reported. The incidental finding rate on thoracoabdominal CT scans in the ED has been reported to be approximately 36%, 77 whereas total-body CT, from the vertex through the pelvis, has a reported incidental findings rate of 45%, 16 with most findings being located in the abdomen.…”

Section: Incidental Findingsmentioning

confidence: 99%

“…15 However, several unanswered questions persist about the role of WBCT in major trauma. These uncertainties surround appropriate patient selection, potentially excessive radiation exposure, management of incidental findings, 16 and potentially increased health care costs. The relative sensitivity, time, and radiation dose of various WBCT scan protocols have not yet been studied sufficiently.…”

Section: Introductionmentioning

confidence: 99%

“…The relative sensitivity, time, and radiation dose of various WBCT scan protocols have not yet been studied sufficiently. Furthermore, there are persistent doubts about the clinical significance of additional injuries detected by WBCT and the mortality benefit of WBCT when compared with selective CT. [15][16][17][18][19][20][21][22][23] This article provides a detailed overview of the current concepts surrounding WBCT in trauma.…”

Section: Introductionmentioning

confidence: 99%

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