Expecting the unexpected: incidental findings at a level 1 trauma center

• Published in: Emergency radiology 2023-06, Vol.30 (3), p.343-349
• Main Authors: Kolbeinsson, Hordur M, Dandamudi, Siddhartha, Gira, Joshua, Krech, Laura, Pounders, Steffen, Fisk, Chelsea, Wright, Gerald Paul, Chapman, Alistair J., Chadwick, Cathryn
• Format: Article
• Language: English
• Subjects: Adrenal glands; Adult; Computed tomography; Diagnostic Imaging; Emergency Medicine; Female; Humans; Imaging; Incidence; Incidental Findings; Male; Medical imaging; Medicine; Medicine & Public Health; Original Article; Radiology; Retrospective Studies; Thyroid gland; Trauma Centers
• ISSN: 1438-1435; 1070-3004; 1438-1435
• DOI: 10.1007/s10140-023-02138-5

Introduction Incidental findings on comprehensive imaging in the adult trauma population occur at rates as high as 54.8%. We sought to determine the incidence of potentially malignant or pre-malignant incidental findings in a high-volume level 1 trauma center and to evaluate follow-up recommendations. Methods This was a retrospective review of all patients with incidental findings on imaging who were admitted to the trauma service at our level 1 trauma center between January 1st, 2014, and October 1st, 2019. A multi-disciplinary team characterized findings as potentially malignant or pre-malignant. Results The study included 495 patients who had incidental findings, 410 of whom had potentially malignant or pre-malignant findings on imaging, resulting in a cumulative incidence of 6.6%. The mean age was 65 and 217 (52.9%) patients were male. The majority of “incidentalomas” were discovered on CT imaging ( n =665, 98.1%); over half were solid ( n =349, 51.5%), while 27.4% were cystic ( n =186) in nature. The lungs ( n =199, 29.4%), kidneys ( n =154, 22.8%), liver ( n =74, 10.9%), thyroid gland ( n =58, 8.6%), and adrenal glands ( n =53, 7.8%) harbored the most incidentalomas. Less than half of patients with incidental findings received specific follow-up recommendations on the radiologist’s report ( n =150, 39%). Sixty-one percent of patients ( n =250) had their incidentalomas detailed in the discharge paperwork. Conclusion The results of our study suggest that potentially malignant or pre-malignant incidental findings are common among trauma patients. Specific follow-up recommendations were not presented in 61% of the radiology reports, highlighting the need to standardize medical record capture of an incidentaloma to ensure adequate and appropriate follow-up.