Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA.
Am Surg. 2023 Jul;89(7):3174-3179. doi: 10.1177/00031348231157822. Epub 2023 Feb 15.
Pan scanning in trauma patients has become routine, resulting in increased identification of incidental findings (IF), findings unrelated to the reason for the scan. This has posed a conundrum of ensuring patients have appropriate follow-up for these findings. We sought to evaluate our compliance and follow-up for patients after implementation of an IF protocol at our level-I trauma center.
We performed a retrospective review from 9/2020 to 4/2021, to encompass before and after protocol implementation. Patients were separated into PRE and POST groups. Charts were reviewed evaluating several factors including three- and six-month follow-ups on IF. Data were analyzed comparing PRE and POST groups.
A total of 1989 patients were identified, 31.22% (n = 621) with an IF. 612 patients were included in our study. Compared to PRE, POST showed a significant increase in PCP notification (35% vs 22%, < .001) and patient notification (82% vs 65%, < .001). As a result, patient follow-up regarding IF at six months was significantly higher in POST (44%) v. PRE (29%), ( < .001). There was no difference in follow-up based on insurance carrier. There was no difference in patient age for PRE (63 y) and POST (66 y) overall, ( = .089); nor in age of patients who followed up; 68.8 PRE vs 68.2 years POST ( = .819).
Implementation of an IF protocol with patient and PCP notification was significantly improved in overall patient follow-up for category one and two IF. Utilizing the results of this study, the protocol will be further revised to improve patient follow-up.
在创伤患者中进行全景扫描已成为常规，这导致偶然发现（IF）的数量增加，这些发现与扫描的原因无关。这就带来了一个难题，即如何确保患者对这些发现进行适当的随访。我们旨在评估在我们的一级创伤中心实施 IF 方案后，患者的依从性和随访情况。
我们对 2020 年 9 月至 2021 年 4 月期间的数据进行了回顾性分析，涵盖了方案实施前后的时间段。患者被分为 PRE 和 POST 两组。我们对病历进行了回顾，评估了包括 IF 的三到六个月随访在内的几个因素。对 PRE 和 POST 两组的数据进行了分析比较。
共确定了 1989 名患者，其中 31.22%（n=621）存在 IF。我们的研究纳入了 612 名患者。与 PRE 相比，POST 组中 PCP 通知（35%比 22%，<0.001）和患者通知（82%比 65%，<0.001）显著增加。因此，POST 组患者对 IF 的六个月随访明显高于 PRE 组（44%比 29%，<0.001）。基于保险类型，随访情况没有差异。PRE 组（63 岁）和 POST 组（66 岁）的患者年龄总体上没有差异（=0.089）；随访患者的年龄也没有差异，PRE 组为 68.8 岁，POST 组为 68.2 岁（=0.819）。
实施 IF 方案并通知患者和 PCP，可显著提高对 I 类和 II 类 IF 的总体患者随访率。利用本研究的结果，我们将进一步修订方案，以提高患者的随访率。
