Original Contributions
The prevalence and implications of incidental findings on ED abdominal CT scans*,**

Presented at the Society of General Internal Medicine (SGIM) Regional Meeting March 31, 2000 and the SGIM National Meeting May 4, 2000.
https://doi.org/10.1053/ajem.2001.27137Get rights and content

Abstract

We reviewed reports from 321 consecutive emergency department (ED) noncontrast, helical “renal stone” abdominal CT scans obtained at a single medical center between April 1996 to June 1997 for incidental findings. Incidental findings were common (45% of scans), and approximately half were rated of “moderate” or “serious” concern by 2 independent reviewers (kappa = 0.72). ED records indicated that only 21% of incidental findings were documented, and only 11 (18%) of cases with findings of “moderate/severe” concern had evidence of follow-up on hospital chart review. Although work-up of these 11 cases did not yield any serious diagnoses, many potentially serious incidental findings without follow-up remain worrisome. (Am J Emerg Med 2001;19:479-481. Copyright © 2001 by W.B. Saunders Company)

Section snippets

Methods

We examined the reports of 321 consecutive abdominal CT scans ordered from our urban university hospital ED between April 1996 and June 1997 using a “renal stone” protocol of helical scanning without contrast. The reports were reviewed for the presence of incidental findings, which were subdivided into the level of concern for serious pathology they generated in the mind of a physician reading the report. Because of the expected wide variety of potential findings, three deliberately general

Results

The mean age of the study subjects was 43 (range 16-81); 64% were men and 67% had evidence of nephrolithiasis on CT. Of 321 reports, 14 were eliminated from further analysis because of either reviewer indicating they revealed alternative diagnoses, which included appendicitis, diverticulitis, and cholelithiasis. A high proportion (145/307) of the remaining reports contained at least one incidental finding, of which 51% raised “moderate” or “severe” concern in the mind of the first reviewer (Fig

Discussion

Incidental findings were common on ED abdominal helical CT scans obtained for suspected renal colic. We found that 45% of 321 scans had incidental findings, about half of which generated “moderate/severe” concern in the minds of 2 independent reviewers. Most of the findings, even when of “moderate/severe concern,” were not noted in the ED record and had no evidence of follow-up over a minimum of 2 years. In fact, in the 61 cases where both reviewers agreed there was at least moderate concern,

Acknowledgements

The authors would like to thank Steven Atlas, MD, for reviewing the Internal Review Board protocol and William Kormos, MD for reviewing the manuscript.

References (11)

There are more references available in the full text version of this article.

Cited by (85)

  • Automatic Detection of Thyroid and Adrenal Incidentals Using Radiology Reports and Deep Learning

    2021, Journal of Surgical Research
    Citation Excerpt :

    While the severity may vary, all findings should be communicated to the patient, their primary care physician, and referred for appropriate follow-up if necessary. However, due to the rapid nature of trauma care, it can be very difficult to document incidental findings, inform the patient and family, communicate to the primary care physician, and schedule appropriate follow-up.9,16 Studies have shown that documentation is consistently missing or inadequate in discharge summaries representing a significant opportunity for improvement.1,9,10,17

View all citing articles on Scopus
*

Address reprint requests to Michael J. Barry, MD, Chief, General Medicine Unit, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114. E-mail: [email protected]

**

0735-6757/01/1906-0005$35.00/0

View full text