CT scan incidental findings in trauma patients: does it impact hospital length of stay?

background CT scans are heavily relied on for assessment of solid organ injuries complementing clinical examination. These CT scans could also reveal pathologies not related to trauma called incidental findings. We aimed to evaluate the frequency of these findings and their outcome on hospital services. Methods A retrospective chart review of prospectively collected data of the emergency department’s trauma database from January 2005 to December 2011 to evaluate incidental findings on CT scans on trauma admissions. These incidental findings were divided into three classes: class 1—minor degenerative, nondegenerative, normal variants or congenital finding that does not require further investigation or workup; class 2—findings not requiring urgent intervention with scheduled outpatient follow-up and class 3—all findings that require urgent evaluation/further investigation during the same hospital admission. One-year follow-up was done to review hospital length of stay, trauma clinic follow-up and post-trauma surgery. results Of 1000 charts reviewed, 957 were selected after 43 patients were excluded due to incomplete documentation. Of the 957 patients, 385 (40%) were found to have incidental findings. A total of 560 incidental findings were found on the CT scan reports with one-third of patients having multiple findings (144 patients, 37.4%). The largest number of incidental findings were in class 2. The incidental group had significantly longer length of stay after adjusted multivariate analysis (8.7±0.48 vs 6.7±0.55, p=0.005). conclusion The incidental findings are commonly found during CT imaging in trauma centers and our rate was 40%. Appropriate documentation, communication and follow-up of those findings is necessary. A classification system for these findings practiced nationwide will aid in categorizing the urgency of continued follow-up. This also will help decrease the length of hospital stay and healthcare cost. Level of evidence Level 4 IntroductIon Except for cardiac events and cancer, trauma remains one of the leading causes of morbidity and mortality in the USA. Based on the US Census Bureau, in 2009 there were 10.8 million accidents leading to over 35 900 deaths.1 Trauma is still the leading cause of death among teenagers and a major cause of morbidity and mortality among the elderly, which is a growing area of concern.2 The modern trauma centers rely heavily on CT scans for assessment of solid organ injuries. Besides providing information on acute trauma-related injuries, CT scans could also reveal pathologies not related to trauma called ‘incidental findings’, which may or may not require further investigation.3–6 The diagnosis and correct treatment of these incidental findings could have an impact on patient's future health. The frequency of incidental findings varies from institution to institution4 7 8 as it depends on patient population, volume of trauma, type of trauma and resources available at the trauma center. The number of incidental findings based on previous published articles has been variable from 30% to as high as 53%.9–14 The aim of this study is to determine the frequency of incidental findings in a level 1 trauma center, hospital length of stay, any intervention performed during or after the admission and 1-year follow-up. The incidental findings will allow for development of a classification system that can be applied to these findings, which will help in their management, improve patient awareness and follow-up. Methods study design We performed a retrospective chart review of all patients who were admitted with a trauma diagnosis from a prospectively maintained New York State Trauma Registry emergency department database between January 2005 and December 2011. Data were collected from electronic medical records with inclusion criteria being all patients who received a CT scan of the head, cervical spine, chest, abdomen and pelvis and/or total body scan that were admitted to the trauma service. Any patient who did not have a CT scan was excluded. The CT scans were reviewed for any type of incidental finding noted on the definitive radiology report. The course of in-hospital stay was reviewed for demographics, past medical history (smoking history, cardiopulmonary disease, history of cancer, any surgical intervention), trauma type (blunt, penetrating), trauma classification (fall, motor vehicle accident (MVA), pedestrian, assault, gunshot wound, stab, other), number of body part involved, injury severity score (ISS), length of stay and discharge disposition. Fall category comprised of all patients with the admitting diagnostic category as fall in the New York Trauma registry. In trauma classification, the ‘other’ category was defined as home accidents, foreign body injuries or blast injury. The primary outcomes were to determine the frequency of incidental findings in our patient population and hospital length of stay. The secondary CT scan incidental findings in trauma patients: does it impact hospital length of stay? Peter Andrawes,1 Antonio I Picon,1,2 Masood A Shariff,1 Basem Azab,1 Wolf von Waagner,1 Seleshi Demissie,3 Charles Fasanya1,4 to cite: Andrawes P, Picon AI, Shariff MA, et al. Trauma Surg Acute Care Open 2017;2:1–6. 1Department of Surgery, Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine, New York, USA 2Department of Surgery— Surgical Oncology, Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine, New York, USA 3Biostatistics Unit, Feinstein Institute for Medical Research at Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine, New York, USA 4Department of Trauma and Critical Care, Staten Island University Hospital, Northwell Health System, Hofstra School of Medicine, New York, USA correspondence to Dr Peter Andrawes; peterabotaga@ yahoo. com, pabotaga@ gmail. com This paper was presented at the 2016 TQIP Annual Meeting in Orlando, Florida. Received 22 March 2017 Revised 18 July 2017 Accepted 8 August 2017 Original Article group.bmj.com on September 26, 2017 Published by http://tsaco.bmj.com/ Downloaded from