Incidental Findings on CT Scans in the Emergency Department

Abstract

Objectives. Incidental findings on computed tomography (CT) scans are common. We sought to examine rates of findings and disclosure among discharged patients who received a CT scan in the ED. Methods. Retrospective chart review (Aug-Oct 2009) of 600 patients age 18 and older discharged home from an urban Level 1 trauma center. CT reports were used to identify incidental findings and discharge paperwork was used to determine whether the patient was informed of these findings. Results. There were 682 CT scans among 600 patients: 199 Abdomen & Pelvis, 405 Head, and 78 Thorax. A total of 348 incidental findings were documented in 228/682 (33.4%) of the scans, of which 34 (9.8%) were reported to patients in discharge paperwork. Patients with 1 incidental finding were less likely to receive disclosure than patients with 2 or more (P = .010). Patients age <60 were less likely to have incidental findings (P < .001). There was no significant disclosure or incidental finding difference by gender. Conclusions. While previous research suggests that CT incidental findings are often benign, reporting to patients is recommended but this is rarely happening.

Incidental findings on total-body CT scans in trauma patients

“…Poor documentation has been described previously [9][10][11][12][13]. Its was shown that less than 20% of the patients with an incidental finding of moderate to severe concern had evidence of follow-up [11].…”

Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis

“…1,2 Abdominal computed tomography (CT) has become the most common initial imaging test for suspected nephrolithiasis because of its high sensitivity for the diagnosis of urinary stone disease. 3 However, CT entails exposure to ionizing radiation with attendant longterm cancer risk, [4][5][6][7] is associated with a high rate of incidental findings 8,9 that can lead to inappropriate follow-up referral and treatment, 10 and contributes to growing annual care costs for acute nephrolithiasis, which are currently approximately $2 billion in the United States. 1,2 No evidence has shown that increased CT use, despite its higher sensitivity, is associated with improved patient outcomes.…”

Incidental findings on MRI of the temporomandibular joint

“…Thompson et al 24 described 31 incidental findings of sinus change in a total of 405 CT head examinations. This is equivalent to the rate of 7.6%.…”