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Incidental findings observed in almost a third of CT scans in emergency departments

According to a systemic review, incidental findings seen on a CT scan in emergency departments are present in nearly a third of cases

The presence of incidental findings (IF) occurs in roughly a third of all computed tomography (CT) scans undertaken with emergency departments according to the findings of a systematic review by a group of US researchers.

The term ‘incidentaloma’ refer to an incidentally discovered mass or lesion, detected using imaging and which was performed for an unrelated reason. Such incidental findings are not uncommon, especially among scans for trauma patients with one study revealing how the findings were present in 15% of trauma CT scans.

Whilst the presence of IF do not affect or alter the emergency department clinician’s current diagnostic work-up, it is important that these observations are communicated to patients so as to ensure that where necessary, appropriate further tests and follow-up are instigated. However, in non-trauma patients, little is known about the level of incidental findings among CT scans undertaken within emergency departments.

For the present study, the US team sought to estimate the prevalence of radiologic IF among patients visiting an emergency department and who underwent a CT scan. A secondary aim was look at how hospitals managed and stratified the risks associated with abnormal findings.

Undertaking a comprehensive literature search, the authors looked for studies including terms such as ‘incidentaloma’ without a restriction on the type of study design and which included those that were retrospective, cross-sectional or prospective in nature. The primary outcome of the systematic review was the prevalence of IF on a CT scan.

Prevalence of incidental findings on CT scans

A total of 69 studies representing 147,763 emergency department encounters or radiology reports, with a median patient sample size of 882, were included in the analysis.

The majority of studies were cross-sectional in design (82.6%) with the remainder comprising cohort (7.2%) and those with a pre- and post-interventional design. Just over half of the studies (50.7%) were in trauma patients and 63.8% of studies included some form a risk stratification of IF.

The pooled prevalence of any incidental finding on CT scan was 31.3% (95% CI 24.4% – 39.1%) although there was marked evidence of heterogeneity in the studies. The highest prevalence of IF occurred in patients having a CT scan because of chest pain (36.6%), followed by trauma (34.7%).

In a total of five studies, all based in trauma centres, there were structural interventions designed to improve the recognition and notification or follow-up of patients identified with an IF on a CT scan. In one such study, for example, following implementation of the strategy to manage IF, patient notification increased from 17.7% to 32.4%.

The researchers also discovered that documentation of IF in the patient’s discharge notes was present in only 20.1% to 47.2% of cases.

In their conclusion, the authors identified the need to establish a comprehensive classification system and standard-based approach to help clinicians when faced with an IF. They also called for more flexible care co-ordination programs to ensure timely follow-up, clear documentation in medical records and which could easily be implemented within a busy emergency department.

Evans CS et al. Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis Ann Emerg Med 2022