Frequency of Incidental Findings and Outcome Measures in Patients Admitted to an Urban Level I Trauma Center

Background: With the advancement in availability and sophistication of computed tomography (CT), a number of patients are being identified with incidental abnormalities or incidentalomas . The purpose of this descriptive analysis is to describe the prevalence of abnormal findings unrelated to injury recognized during trauma evaluation at a Level I Trauma Center and determine if appropriate follow-up occurred. Methods: A retrospective cohort analysis of all head, spine, face, chest, abdomen, and pelvic CT scan reports in adult patients admitted to a Level I urban Trauma Center over a three month period was undertaken to determine the frequency of incidental findings and subsequent follow-up either in the acute care or outpatient setting. Results: A total of 500 consecutive patients received 3,460 CT scans with an average of 6.9 scans per person per admission. The population was predominantly male (71 %) with a mean age of 45 years. Incidentalomas were found in 65% of patients (325/500) yielding 760 individual findings. The most common incidentaloma involved degenerative spine disease in 50% followed by liver, head and neck, kidney, and other diagnoses. Further follow-up was recommended in 80 radiology reports with 27 of those indicating future follow-up. Twenty-six diagnostic studies and ten specialist consultations subsequently occurred. Discussion: Incidentalomas are becoming increasingly common with the utilization of sensitive scanning by computed tomography. Our findings are consistent with those of other studies that have determined the frequency of the incidentaloma. We also encountered similar challenges regarding incomplete follow-up of those patients needing systematic follow-up. Several issues impending adequate follow-up probable in our population include, lack of insurance, transportation, or other social situations encountered in the trauma population as well as inconsistencies in staff communication, recommendations, and adequate description of findings