Extraurinary Incidental Findings on CT for Hematuria: The Radiologist's Role and Downstream Cost Analysis

Morgan, Andrew E; Berland, Lincoln L.; Ananyev, Sergey S.; Lockhart, Mark E.; Kolettis, Peter N.

doi:10.2214/ajr.14.12483

Cited by 22 publications

(29 citation statements)

References 32 publications

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“…1,2 Second, CT overutilization can lead to increased costs related to the test 3 and prolonged length of stay related to additional evaluation of incidental findings. 4,5 Finally, false-positive results from CT scanning can lead to increased patient morbidity. 6,7 Several reports examining pediatric CT scanning for particular indications, including head trauma and appendicitis, suggest that variability across hospitals exists and is in part due to differences in institutional practice, availability of CT, and lack of protocol-driven decision-making on when to image.…”

Section: What This Study Addsmentioning

confidence: 99%

Variation in Utilization of Computed Tomography Imaging at Tertiary Pediatric Hospitals

et al. 2015

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BACKGROUND: Recent efforts have focused on reducing computed tomography (CT) imaging in children. Although published reports show variability in CT scanning for specific indications, an assessment of the effects of institutional factors (case-mix or hospital volume) on the rate of CT scanning for any indication is necessary to better understand variability across pediatric hospitals. METHODS:Data from 2009 to 2013 on inpatient, observation, and emergency department (ED) encounters were extracted from the Pediatric Health Information System. Chronological trends and institutional variability in CT scan rates were examined by using negative binomial regression models. Case-mix was adjusted by using All Patient Refined Diagnosis Related Groups and severity level.RESULTS: Thirty hospitals were included. There were 12 531 184 patient encounters and 701 644 CT scans resulting in a mean of 56 scans per 1000 encounters (range: 26-108). The most common scan types were head (60.1%) and abdomen/pelvis (19.9%). There was an inverse relationship between the CT scan rate and hospital volume (P = .002) and a direct relationship between the CT scan rates for inpatient/observation and ED encounters (P , .001). The rate of CT imaging decreased from 69.2 to 49.6 scans per 1000 encounters during the study period (P , .001). CONCLUSIONS:The overall use of CT imaging is decreasing, and significant variability remains in CT use across tertiary pediatric hospitals. Hospital volume and institutional-level practices account for a significant portion of the variability. This finding suggests an opportunity for standardization through multi-institutional quality improvement projects to reduce CT imaging. WHAT'S KNOWN ON THIS SUBJECT:Given the efforts to decrease the use of ionizing radiation in pediatric patients, there is significant variability in head computed tomography (CT) scan use in pediatric emergency departments for minor head trauma. WHAT THIS STUDY ADDS:This study characterized variability in CT scan rates for all body regions in emergency department, observation, and inpatient encounters across 30 tertiary pediatric hospitals. Two-fold variation remained after case-mix adjustment, with higher volume hospitals having lower rates of CT scanning.

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Section: What This Study Addsmentioning

confidence: 99%

Variation in Utilization of Computed Tomography Imaging at Tertiary Pediatric Hospitals

et al. 2015

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“…Where applicable, ioversol 320 (Optiray; Mallinckrodt, St Louis, Mo) was used as the intravenous contrast agent. The amount of administered contrast material varied according to patient weight: from the work-up of incidental findings through image-guided biopsy (5) or splenectomy (6), including death from treatment of incidental abnormalities (7).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with SANT are only rarely symptomatic (three of nine, 37%) with abdominal MR imaging evaluation of all complex/ solid splenic masses, while other authors have proposed image-guided biopsy in certain clinical scenarios with nonspecific imaging features (20). Such a practice would increase health care costs and potentially expose patients to increased morbidity and mortality (7). An example of patient morbidity resulting from such a follow-up recommendation is illustrated by one patient Axial CT image of abdomen acquired with oral and intravenous contrast material demonstrates splenic mass (black arrow) and perisplenic lymphadenopathy (white arrows), raising concern for lymphoma.…”

Section: Symptomatic Patientsmentioning

confidence: 99%

The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study

et al. 2018

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Purpose To evaluate whether an incidentally noted splenic mass at abdominal computed tomography (CT) requires further imaging work-up. Materials and Methods In this institutional review board-approved HIPAA-compliant retrospective study, a search of a CT database was performed for patients with splenic masses at CT examinations of the abdomen and chest from 2002 to 2008. Patients were divided into three groups: group 1, patients with a history of malignancy; group 2, patients with symptoms such as weight loss, fever, or pain related to the left upper quadrant and epigastrium; and group 3, patients with incidental findings. Patients' CT scans, follow-up examinations, and electronic medical records were reviewed. Final diagnoses of the causes of the masses were confirmed with imaging follow-up (83.9%), clinical follow-up (13.7%), and pathologic examination (2.4%). Results This study included 379 patients, 214 (56.5%) women and 165 (43.5%) men, with a mean age ± standard deviation of 59.3 years ± 15.3 (range, 21-97 years). There were 145 (38.3%) patients in the malignancy group, 29 (7.6%) patients in the symptomatic group, and 205 (54.1%) patients in the incidental group. The incidence of malignant splenic masses was 49 of 145 (33.8%) in the malignancy group, eight of 29 (27.6%) in the symptomatic group, and two of 205 (1.0%) in the incidental group (P < .0001). The incidental group consisted of new diagnoses of lymphoma in one (50%) patient and metastases from ovarian carcinoma in one (50%) patient. Malignant splenic masses in the incidental group were not indeterminate, because synchronous tumors in other organs were diagnostic of malignancy. Conclusion In an incidental splenic mass, the likelihood of malignancy is very low (1.0%). Therefore, follow-up of incidental splenic masses may not be indicated. RSNA, 2018.

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“…Other interventions include primary care office visits, subspecialist referrals, diagnostic and therapeutic procedures, surgical procedures, and hospitalizations related to these procedures with considerable costs involved. 10 Although there are several publications in the literature addressing costs associated with IFs. 4,10 The reverse calculations estimating health care cost savings related to future morbidity and mortality had these findings gone undiscovered, cannot be quantified and remain unclear.…”

mentioning

confidence: 99%

“…10 Although there are several publications in the literature addressing costs associated with IFs. 4,10 The reverse calculations estimating health care cost savings related to future morbidity and mortality had these findings gone undiscovered, cannot be quantified and remain unclear. IF-related costs have also raised concerns with the government and third-party payers as medical imaging utilization have risen.…”

mentioning

confidence: 99%

The good, bad, and ugly of incidental findings on cardiovascular-computed tomography

Bhambhvani

2016

Journal of Nuclear Cardiology

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Extraurinary Incidental Findings on CT for Hematuria: The Radiologist's Role and Downstream Cost Analysis

Cited by 22 publications

References 32 publications

Variation in Utilization of Computed Tomography Imaging at Tertiary Pediatric Hospitals

Variation in Utilization of Computed Tomography Imaging at Tertiary Pediatric Hospitals

The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study

The good, bad, and ugly of incidental findings on cardiovascular-computed tomography

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