Nicht traumaassozierte Nebenbefunde bei Ganzkörpercomputertomografien im Rahmen der Polytraumadiagnostik

Hoffstetter, Patrick; Herold, Thomas; Daneschnejad, M; Zorger, N.; Jung, Eunju; Feuerbach, S.; Schreyer, A. G.

doi:10.1055/s-2007-963594

Cited by 32 publications

(18 citation statements)

References 6 publications

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“…The majority of Category 1 findings were discovered predominantly on CT scans of the abdomen (49.4%) and the chest (20.7%). Similar results were obtained by others analysing single CT scans of the chest or other body regions [10],[11] Analogous to our results Hofstetter et al [17] also found 6.6% incidental findings of clinically high importance in their series of 304 multiple injured patients receiving whole-body CT with a consistent protocol. Incidental findings of moderate importance were described in 22.7%, which is more than twice as high compared to our study cohort.…”

Section: Discussionsupporting

confidence: 92%

“…Consistent with our data incidental findings in whole body CT scans for severely injured patients are very prevalent with up to 50% [16],[17]. We detected incidental findings in 43.3% of 534 scans with 9.0% and 6.7% classified as moderately and highly relevant in terms of clinical importance, respectively.…”

Section: Discussionsupporting

confidence: 90%

“…This can be explained by different definitions of findings with moderate importance. Degenerative skeletal disease represented the largest portion of findings with moderate importance in the study of Hofstetter et al [17]. Contrary, we excluded degenerative skeletal disease in our study population for two reasons.…”

Section: Discussionmentioning

confidence: 99%

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Retrospective analysis of incidental non-trauma associated findings in severely injured patients identified by whole-body spiral CT scans

2014

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BackgroundWhole-body Computed Tomography (CT) scan today is considered a crucial imaging technique in the diagnostic work-up of polytrauma patients implicating a potential survival benefit. Apart from prompt identification of life threatening injuries this imaging technique provides an additional benefit by diagnosing incidental non-trauma associated medical diseases. These incidental findings might be also life threatening and warrant urgent therapy. The downside of whole-body CT is a relatively high radiation exposure that might result in an increased life time cancer risk. The aim of this study was to investigate the frequency and type of non trauma associated incidental medical findings in relation to patient age and potential clinical relevance.MethodsBetween January 1st 2011 and December 15th 2012, a total of 704 trauma patients were referred to our hospital’s emergency room that triggered trauma room alarm according to our trauma mechanism criteria. Of these 534 (75.8%) received a whole-body CT according to our dedicated multiple trauma protocol. Incidental Findings (IF) were assigned in three groups according to their clinical relevance. Category 1: IF with high medical relevance (urgent life threatening conditions, unless treated) needing early investigations and intervention prior to or shortly after hospital discharge. Category 2: IF with intermediate or low medical relevance, warranting further investigations. Category 3: IF without clinical relevance.ResultsOverall 231 IFs (43.3%) were identified, 36 (6.7%) patients had IFs with a high clinical relevance, 48 (9.0%) with a moderate or minor clinical relevance and 147 (27.5%) with no clinical relevance. The distribution of incidental findings with high or moderate relevance according to age showed an incidence of 2.6%, 6.6% and 8.8% for patients younger than 40 years, 40 to 60 years and older than 60 years, respectively.ConclusionWhole-body CT scans of trauma patients demonstrate a high rate of incidental findings. Potentially life-threatening, medical findings were found in approximately every 15th patient, predominantly aged over 40 years and presenting with minor to moderate injuries and an Injury Severity Score (ISS) of 10 or less.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

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Retrospective analysis of incidental non-trauma associated findings in severely injured patients identified by whole-body spiral CT scans

2014

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“…These studies, however, did not directly compare these to incidental findings with selective CT scanning. The study by Hofstetter et al found incidental findings in 50 % of their patients, with 29 % of these possibly requiring follow-up [7]. In a study by Barett et al, findings were detected in 53 % of all patients by TBCT, 59 % of which required urgent follow-up [6].…”

Section: Discussionmentioning

confidence: 99%

High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial

et al. 2016

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ObjectivesTo determine whether there is a difference in frequency and clinical relevance of incidental findings detected by total-body computed tomography scanning (TBCT) compared to those by the standard work-up (STWU) with selective computed tomography (CT) scanning.MethodsTrauma patients from five trauma centres were randomized between April 2011 and January 2014 to TBCT imaging or STWU consisting of conventional imaging with selective CT scanning. Incidental findings were divided into three categories: 1) major finding, may cause mortality; 2) moderate finding, may cause morbidity; and 3) minor finding, hardly relevant. Generalized estimating equations were applied to assess differences in incidental findings.ResultsIn total, 1083 patients were enrolled, of which 541 patients (49.9 %) were randomized for TBCT and 542 patients (50.1 %) for STWU. Major findings were detected in 23 patients (4.3 %) in the TBCT group compared to 9 patients (1.7 %) in the STWU group (adjusted rate ratio 2.851; 95%CI 1.337–6.077; p < 0.007). Findings of moderate relevance were detected in 120 patients (22.2 %) in the TBCT group compared to 86 patients (15.9 %) in the STWU group (adjusted rate ratio 1.421; 95%CI 1.088–1.854; p < 0.010).ConclusionsCompared to selective CT scanning, more patients with clinically relevant incidental findings can be expected by TBCT scanning.Key points• Total-body CT scanning in trauma results in 1.5 times more incidental findings.• Evaluation by TBCT in trauma results in more patients with incidental findings.• In every category of clinical relevance, TBCT detects more incidental findings.

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“…Out of a total number of 767 examinations we identified 56 patients fulfilling the following criteria: [1] indication of examination must be minor blunt thorax trauma (No respiratory distress, conscious patient, no critical condition or vital danger), [2] patients received an additional CT of the thorax, [3] CT must have been performed within two weeks after radiography, and there may be no new trauma. 39 of the 56 included Patients received additionally plain chest film (PCF).…”

Section: Methodsmentioning

confidence: 99%

Diagnostic significance of rib series in minor thorax trauma compared to plain chest film and computed tomography

Hoffstetter¹,

Dornia²,

Schäfer³

et al. 2014

J Trauma Manage Outcomes

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BackgroundRib series (RS) are a special radiological technique to improve the visualization of the bony parts of the chest.ObjectivesThe aim of this study was to evaluate the diagnostic accuracy of rib series in minor thorax trauma.MethodsRetrospective study of 56 patients who received RS, 39 patients where additionally evaluated by plain chest film (PCF). All patients underwent a computed tomography (CT) of the chest. RS and PCF were re-read independently by three radiologists, the results were compared with the CT as goldstandard. Sensitivity, specificity, negative and positive predictive value were calculated. Significance in the differences of findings was determined by McNemar test, interobserver variability by Cohens kappa test.Results56 patients were evaluated (34 men, 22 women, mean age =61 y.). In 22 patients one or more rib fracture could be identified by CT. In 18 of these cases (82%) the correct diagnosis was made by RS, in 16 cases (73%) the correct number of involved ribs was detected. These differences were significant (p = 0.03). Specificity was 100%, negative and positive predictive value were 85% and 100%. Kappa values for the interobserver agreement was 0.92-0.96. Sensitivity of PCF was 46% and was significantly lower (p = 0.008) compared to CT.ConclusionsRib series does not seem to be an useful examination in evaluating minor thorax trauma. CT seems to be the method of choice to detect rib fractures, but the clinical value of the radiological proof has to be discussed and investigated in larger follow up studies.

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Nicht traumaassozierte Nebenbefunde bei Ganzkörpercomputertomografien im Rahmen der Polytraumadiagnostik

Cited by 32 publications

References 6 publications

Retrospective analysis of incidental non-trauma associated findings in severely injured patients identified by whole-body spiral CT scans

Retrospective analysis of incidental non-trauma associated findings in severely injured patients identified by whole-body spiral CT scans

High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial

Diagnostic significance of rib series in minor thorax trauma compared to plain chest film and computed tomography

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