Kursat ERMAN, Cihan BEDEL, Mustafa KORKUT

Evaluation of incidental findings of whole body computed tomography in multiple trauma patients in emergency department

Aim: The aim of this study was to investigate the frequency of incidental findings and the clinically significant ones in whole-bodycomputed tomography (WBCT) scans in multiple trauma patients in the emergency department (ED).Material and Methods: This study was designed as a single-centered retrospective cohort in a tertiary emergency room. Multipletrauma patients who were screened with WBCT in the ED in 2017 were analyzed. Incidental findings (IF) were categorized into 3groups as group 1 (emergency treatment / need further examination), group 2 (need examination depending on the symptoms ofpatients) and group 3 (minor findings with no need for further examination).Results: WBCT screening was performed in 206 of 3746 patients (5.4%) who were admitted to the trauma unit in ED due to multipletraumas. A total of 360 IFs were found in 138 (67%) of 206 patients. Of the patients, 13.3% were classified as group 1, 30.9% as group2, 55.8% as group 3 and IF was detected, respectively (48, 111, 201). Cardiomegaly was the most common finding in group 1 (n =11). In group 2, hepatomegaly (n = 18) and atherosclerosis (n = 13) were the most common ones observed. Brain calcifications (n= 42) and renal cysts (n = 17) were the most common findings in Group 3. The age distribution of patients with IF was statisticallysignificantly higher compared to those without IF (43.54 ± 18.78, 25.16 ± 11.7, p

PDF

___

1. French SD, Green ME, Bhatia RS, et al. Imaging use for low back pain by Ontario primary care clinicians: protocol for a mixed methods study the Back ON study. BMC Musculoskelet Disord 2019;20:50.
2. van Vugt R, Kool DR, Deunk J, et al. Effects on mortality, treatment, and time management as a result of routine use of total body computed tomography in blunt high-energy trauma patients. J Trauma Acute Care Surg 2012;72:553-9.
3. Sierink JC, Treskes K, Edwards MJ, et al. Immediate totalbody CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. The Lancet 2016;388:673-83.
4. Gordic S, Alkadhi H, Hodel S, et al. Whole-body CT-based imaging algorithm for multiple trauma patients: radiation dose and time to diagnosis. Br J Radiol 2015;88:20140616.
5. Barrett TW, Schierling M, Zhou C, et al. Prevalence of incidental findings in trauma patients detected by computed tomography imaging. Am J Emerg Med 2009;27:428-35.
6. Paluska TR, Sise MJ, Sack DI, et al. Incidental CT findings in trauma patients: incidence and implications for care of the injured. J Trauma Acute Care Surg 2007;62:157-61.
7. Munk MD, Peitzman AB, Hostler DP, et al. Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center. J Emerg Med 2010;38:346-50.
8. Samim M, Goss S, Luty S, et al. Incidental findings on CT for suspected renal colic in emergency department patients: prevalence and types in 5,383 consecutive examinations. J Am Coll Radiol 2015;12:63-9.
9. van Vugt R, Dekker HM, Deunk J, et al. Incidental findings on routine thoracoabdominal computed tomography in blunt trauma patients. J Trauma Acute Care Surg 2012;72:416- 21.
10. Sierink J, Saltzherr T, Russchen M, et al. Incidental findings on total-body CT scans in trauma patients. Injury 2014;45:840-4.
11. Hoffstetter P, Herold T, Daneschnejad M, et al. Nontrauma- associated additional findings in whole-body CT examinations in patients with multiple trauma. Rofo 2008;180:120-6.
12. Huber-Wagner S, Kanz KG, Hanschen M,et al. Whole-body computed tomography in severely injured patients. Curr Opin Crit Care 2018;24:55-61.
13. Fakler JK, Özkurtul O, Josten C. Retrospective analysis of incidental non-trauma associated findings in severely injured patients identified by whole-body spiral CT scans. Patient Saf Surg 2014;8:36.
14. Kroczek EK, Wieners G, Steffen I, et al. Non-traumatic incidental findings in patients undergoing whole-body computed tomography at initial emergency admission. Emerg Med J 2017;34:643-6.
15. Thompson RJ, Wojcik SM, Grant WD, et al. Incidental findings on CT scans in the emergency department. Emerg Med Int 2011;2011:624847.
16. Ruesseler M, Schill A, Lehnert T, et al. Incidental findings in patients with multiple injuries: how to proceed? J Trauma Acute Care Surg 2013;75:848-53.
17. Andrawes P, Picon AI, Shariff MA, et al. CT scan incidental findings in trauma patients: does it impact hospital length of stay? Trauma Surg Acute Care Open 2017;2:101.