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

Abstract

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.

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

“…Consistent with our data, incidental findings in whole-body CT scans for severely injured patients are very prevalent [ 9 , 10 ]. However, the overall rate of incidental findings in trauma patients in this present study was considerably lower compared to other published literature (up to 75%) [ 7 , 9 - 12 ]. There were factors such as age, type of trauma, and type of CT that may be the reason for the lower rate.…”

The clinical implications of using a low threshold for computed tomography scans in older patients presenting with a proximal femur fracture

“…Also, in 28 (93.3%) of the 30 patients, the incidental finding did not lead to an immediate alteration in clinical management. Other studies have reported a range of incidental findings [35][36][37]. For instance, a study by Niedermeier et al found incidental findings in 73.9% of the patients receiving a CT scan as part of the emergency work-up of elderly patients with low-energy falls [36].…”

“…Other studies have reported a range of incidental findings [35][36][37]. For instance, a study by Niedermeier et al found incidental findings in 73.9% of the patients receiving a CT scan as part of the emergency work-up of elderly patients with low-energy falls [36]. Incidental findings were most often discovered with a CT head, CT chest, and CT abdomen.…”

Clinical history and incidental abnormality detection in endodontic cone beam computed tomography

“…2 Another study on elderly patients with low-energy falls showed that in CT examinations, 74% of patients had incidental findings. 3 The significance of these missed incidental findings is that if a disease entity remains undetected and unmanaged, disease can progress, and patient outcomes can worsen.…”

“…Emergency patients receiving CT scans were reported to have incidental findings in one third of cases but only 9.8% were reported to patients in discharge paperwork 2 . Another study on elderly patients with low-energy falls showed that in CT examinations, 74% of patients had incidental findings 3 . The significance of these missed incidental findings is that if a disease entity remains undetected and unmanaged, disease can progress, and patient outcomes can worsen.…”