Sierink J C, Saltzherr T P, Russchen M J A M, de Castro S M M, Beenen L F M, Schep N W L, Goslings J C
Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Injury. 2014 May;45(5):840-4. doi: 10.1016/j.injury.2013.10.009. Epub 2013 Oct 30.
Total-body Computed Tomography (CT) scans are increasingly used in trauma care. Herewith the observation of incidental findings, trauma unrelated findings, is also increased. The aim of this study was to evaluate the number of incidental findings in adult trauma patients.
All consecutive trauma patients that underwent total-body CT scanning between January 2009 and December 2011 were analysed. Incidental findings were divided in three categories: category I (potentially severe condition, further diagnostic work-up is required), category II (diagnostic work-up dependent on patients' symptoms) and category III (findings of minor concern, no diagnostic work-up required).
There were 2248 trauma room presentations; 321 patients underwent a total-body CT scan (14.3%). In 143 patients (44.5%), 186 incidental findings were reported. There were 13 category I findings (7.0%), 45 category II findings (24.2%) and 128 category III incidental findings (68.8%). Overall, 18 patients (5.6%) required additional diagnostic work-up. Four patients underwent work-up by additional radiologic imaging. Three patients required further invasive work-up or treatment. Three patients were transferred to another hospital, no extended follow-up was performed. In three patients, there was no documentation of follow-up. Five patients deceased before diagnostic work-up of the incidental finding could start.
Total-body CT scanning as part of the evaluation of trauma patients leads to a substantial amount of incidental findings. Documentation of incidental findings and their clinical consequences was incomplete. Therefore, the findings of this study have prompted us to add an item to our electronic trauma room report that obliges residents to report whether or not incidental findings are found during trauma imaging.
全身计算机断层扫描（CT）在创伤治疗中的应用越来越广泛。因此，偶然发现（与创伤无关的发现）的情况也有所增加。本研究的目的是评估成年创伤患者中偶然发现的数量。
对2009年1月至2011年12月期间接受全身CT扫描的所有连续创伤患者进行分析。偶然发现分为三类：I类（潜在严重情况，需要进一步诊断检查）、II类（诊断检查取决于患者症状）和III类（关注程度较低的发现，无需诊断检查）。
共有2248例患者进入创伤室；321例患者接受了全身CT扫描（14.3%）。143例患者（44.5%）报告了186项偶然发现。其中有13项I类发现（7.0%）、45项II类发现（24.2%）和128项III类偶然发现（68.8%）。总体而言，18例患者（5.6%）需要额外的诊断检查。4例患者通过额外的放射影像学检查进行了进一步检查。3例患者需要进一步的侵入性检查或治疗。3例患者转至另一家医院，未进行延长随访。3例患者没有随访记录。5例患者在偶然发现的诊断检查开始前死亡。
作为创伤患者评估一部分的全身CT扫描会导致大量偶然发现。偶然发现及其临床后果的记录不完整。因此，本研究结果促使我们在电子创伤室报告中增加一项内容，要求住院医生报告在创伤成像过程中是否发现偶然发现。
