Documentation and Follow-Up of Incidental Findings Found on Trauma CT Scan Imaging: A Scoping Review

Incidental findings (IFs) on computed tomography (CT) scans are increasingly detected during trauma workup, with prevalence rates exceeding 50% in some studies. While early detection of potentially serious conditions is critical, less than half of IFs are documented, resulting in poor follow-up. We aimed to characterize IFs, describe IF documentation and follow-up frequency, and recognize interventions to improve IF reporting and follow-up.

A scoping review was conducted using Medline and PubMed, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search focused on English-language studies published between January 2000 and November 2024, with search terms including "incidental findings," "trauma," and "CT" or "computed tomography." Studies were selected based on relevance, excluding nontrauma populations and non-CT imaging studies. A total of 47 articles were included in the final review.

The scoping review identified that IFs are found in 44.5% to 73.9% of trauma patients. The most common IFs are in the lungs (29.4%), kidneys (22.8%), liver (10.9%), thyroid gland (8.6%), and adrenal glands (7.8%). Those concerning for neoplasm included pulmonary nodules (31.1%), liver masses (15.7%), and renal masses (5.7%). Both the severity and frequency of IFs increase with age and body mass index. IF documentation, with or without recommendations for follow-up, was inconsistent, with reporting ranging from 3% for minor IFs to 85% for clinically significant IFs. Documented patient follow-up rates were only seen in 27% to 50% of cases. Institutional interventions that demonstrated improved reporting and follow-up included implementing a dedicated radiologist for IF reporting, delivering education materials on IF follow-up consensus guidelines to radiologists, employing an IF coordinator, and creating electronic medical record integrated IF reporting tools.

IFs are commonly found during trauma workup, but documentation and patient follow-up remain low. Dedicated interventions and tailored institutional guidelines are needed alongside continuous quality improvement efforts, to improve IF reporting and follow-up in trauma care.