Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis

Evans, Christopher S.; Arthur, Rodney; Kane, Michael T.; Omofoye, Fola; Chung, Arlene E.; Moreton, Elizabeth; Moore, Carlton

doi:10.1016/j.annemergmed.2022.03.027

Cited by 14 publications

(5 citation statements)

References 72 publications

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“…Characterising incidentalomas and assessing their potential to progress to serious disease has proved challenging. The reported frequency of incidentalomas detected in the same organs varies considerably 1‐3 . This may reflect different incidentaloma prevalence in different patient populations (eg, ethnicity and age), or differences in how radiologists take images of, classify and report incidentalomas.…”

Section: Benefits and Harms Of Early Detectionmentioning

confidence: 99%

“…In cases involving other organs, radiologists can issue very different recommendations, reflecting ongoing uncertainty around prognosis. Highly suspicious lesions, or those with markedly elevated biomarkers (eg, prostate‐specific antigen in prostate cancer, hormonal levels in adrenal cancers), clearly warrant intervention, but these are the rare exceptions rather than the rule 1‐3 …”

Section: Managing Incidentalomasmentioning

confidence: 99%

“…Incidentalomas are lesions, usually asymptomatic, serendipitously detected in patients undergoing imaging for an unrelated reason 1 . They occur in about 15–30% of all diagnostic imaging tests and 20–40% of computed tomography (CT) and magnetic resonance imaging (MRI) scans 1‐3 . Increasing use of these imaging tests, an ageing population, and enhanced image resolution of modern machines are driving a surge in incidentalomas 1,4,5 .…”

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confidence: 99%

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First do no harm in responding to incidental imaging findings

Scott,

Slavotinek,

Glasziou

2023

Medical Journal of Australia

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Section: Benefits and Harms Of Early Detectionmentioning

confidence: 99%

Section: Managing Incidentalomasmentioning

confidence: 99%

mentioning

confidence: 99%

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First do no harm in responding to incidental imaging findings

Scott,

Slavotinek,

Glasziou

2023

Medical Journal of Australia

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“…An incidental finding is characterized by the identification of a new mass or lesion during imaging that was done for an unrelated purpose. The chance to identify an incidental finding could lead to the early detection of perilous diseases, such as cancer [ 3 ]. Over the last three decades, a rise in the use of cross-sectional imaging tests has resulted in a significant increase in the number of incidental findings discovered that are unrelated to the examination and clinical queries [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Incidental Computed Tomography Findings Among Traumatized Adults: A One-Year Analysis at a Trauma Center

Sabiq,

Alzauir,

Alenizi

2024

Cureus

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Background Computed tomography (CT) for patients with trauma represents a widely accepted diagnostic method. Non-trauma-related incidentalomas or incidental findings are commonly depicted based on CT examination. Our study aimed to assess the frequency of incidental findings on CT scans among traumatized adult patients during one year at a trauma center. Methods We performed a retrospective case review of all adult patients triaged at the King Abdullah Medical Complex trauma service in Jeddah, Saudi Arabia, between 31 May 2022 and 30 May 2023. Patients under the age of 18 were excluded from the study. Patients who could not complete radiographic studies due to deterioration in condition, patients with missing CT scan reports, and transfer patients who had CT scans done at outside facilities were excluded. Demographic data, including age, sex, type of trauma, and type of CT, were recorded. All CT studies were reviewed for incidental findings. Results A total of 106 incidental findings were discovered in 99 patients. The rate of incidental findings for one year was 1.87%. The average age was 41.19 ± 17.90 years, with 73 (73.7%) male and 26 (26.3%) female patients. In trauma classifications, road traffic accidents were the most common (59.60%), followed by falls (33.33%), penetrating trauma (3.03%), and others. A high number of scans for the whole body (56.57%); face, brain, and cervix (13.13%); chest and abdomen/pelvis (11%); and spine (5.05%) had incidental findings. Genitourinary-related incidental findings were observed in 27.36% of patients, followed by craniospinal (16.98%), pulmonary (12.26%), hepatobiliary (9.43%), endocrine (9.43%), and musculoskeletal (5.66%). Conclusion In trauma centers, incidental findings are frequently discovered during CT imaging. In contrast, our center has a lower incidental finding rate. A whole-body CT scan yielded more incident findings than a selective one. The incidental findings are prevalent in the genitourinary system and higher in young male patients. It is important to properly document, communicate, and follow up on these incidental discoveries.

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“… 6 , 7 This dramatic increase in imaging studies presents numerous potential negative implications, including increased healthcare costs, risks of radiation, longer lengths of stay, more incidental findings, and inefficiencies in ED throughput. 8 – 10 Therefore, it is a valuable objective to moderate the use of imaging in the ED to avoid unnecessary imaging.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Overutilization of Computed Tomography of the Cervical Spine

Chamberlin,

Canellas,

Reznek

et al. 2023

WestJEM

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Introduction Despite the wide availability of clinical decision rules for imaging of the cervical spine after a traumatic injury (eg, NEXUS C-spine rule and Canadian C-spine rule), there is significant overutilization of computed tomography (CT) imaging in patients who are deemed to be at low risk for a clinically significant cervical spine injury by these clinical decision rules. The purpose of this study was to identify the major factors associated with the overuse of CT cervical spine imaging using a logistic regression model. Methods This was a retrospective review of all adult patients who underwent CT cervical spine imaging for evaluation of a traumatic injury at a tertiary academic emergency department (ED) and three affiliate community EDs in January and February 2019. We performed multivariable logistic regression to identify factors associated with obtaining CT cervical spine imaging despite low-risk classification by the NEXUS C-spine Rule. Results A total of 1,051 patients underwent CT cervical spine imaging for traumatic indications during the study period, and 889 patients were included in the analysis. Of these patients, 376 (42.3%) were negative by the NEXUS C-spine rule. Variables that were associated with increased likelihood of unnecessary imaging included age over 65, Emergency Severity Index (ESI) score 2 and 3, arrival as a walk-in, and anticoagulation status. Patients who presented to the tertiary academic ED had a significantly lower likelihood of unnecessary imaging. Twenty-one patients (2.4%) were found to have cervical spine fractures on imaging, two of whom were negative by the NEXUS C-spine rule, but neither had a clinically significant fracture. Conclusion Cervical spine imaging is vastly overused in patients presenting to the ED with traumatic injuries, as adjudicated using the NEXUS C-spine rule as a reference standard. Older age, ESI level, arrival as a walk-in, and taking anticoagulation drugs were associated with overutilization of CT imaging. Conversely, presenting to the tertiary academic ED was associated with a lower likelihood of undergoing unnecessary imaging. This model can guide future interventions to optimize ED CT utilization and minimize unnecessary testing.

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Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis

Cited by 14 publications

References 72 publications

First do no harm in responding to incidental imaging findings

First do no harm in responding to incidental imaging findings

Incidental Computed Tomography Findings Among Traumatized Adults: A One-Year Analysis at a Trauma Center

Factors Associated with Overutilization of Computed Tomography of the Cervical Spine

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