Expecting the unexpected: incidental findings at a level 1 trauma center

Area of Science:

• Radiology
• Trauma Surgery
• Oncology

Background:

• Incidental findings on comprehensive imaging are frequent in adult trauma patients, with reported rates up to 54.8%.
• The clinical significance and management of these findings, particularly potentially malignant ones, require further investigation.

Purpose of the Study:

• To determine the incidence of potentially malignant or pre-malignant incidental findings in adult trauma patients at a Level 1 trauma center.
• To evaluate the adequacy of follow-up recommendations provided in radiology reports and discharge paperwork.

Main Methods:

• Retrospective review of imaging findings for trauma patients admitted between January 1, 2014, and October 1, 2019.
• A multidisciplinary team characterized incidental findings as potentially malignant or pre-malignant.

Main Results:

• A cumulative incidence of 6.6% for potentially malignant or pre-malignant incidental findings was observed in 495 patients.
• The lungs, kidneys, liver, thyroid, and adrenal glands were the most common sites for these findings, predominantly on CT scans.
• Specific follow-up recommendations were absent in 61% of radiology reports, though 61% of patients had findings detailed in discharge paperwork.

Conclusions:

• Potentially malignant or pre-malignant incidental findings are a significant concern in the adult trauma population.
• There is a critical need to standardize the documentation and follow-up of incidentalomas in medical records to ensure appropriate patient care.