Abstract：
BACKGROUND: Imaging may inadvertently reveal pathologies unrelated to their performing purpose, known as incidental findings (IF). This study aimed to assess the prevalence, clinical significance, and documentation of IFs in chest and abdominopelvic computed tomography (CT) scans of trauma patients.
METHODS: This observational study was conducted at two urban level-1 trauma centers from March 2019 through April 2022. Official radiology reports of trauma patients who underwent chest and/or abdominopelvic CT scans at the emergency department (ED) were explored, and IF were extracted. Predictive factors of the presence of IFs and their documenting were investigated.
RESULTS: Out of 656 chest and 658 abdominopelvic CT scans, 167 (25.37%) and 212 (32.31%) scans harbored at least one IF, respectively. Patients with IFs tended to be of higher age and female in both chest (age: 48 [IQR: 35-62] vs. 34 [IQR: 25-42.5]; female: 31.14% vs 14.66%, p < 0.001 for both) and abdominopelvic CT scans (age: 41 [IQR: 30-57.5] vs 33 [IQR: 25-43], female: 26.42% vs. 13.96%, p < 0.001 for both). As for documentation of significant IFs, only 49 of 112 chest IFs (43.8%) and 55 of 176 abdominopelvic IFs (31.3%) were documented. Investigating factors associated with documentation of clinically significant IFs, shorter length of hospital stay (1.5 (IQR: 0-4) vs. 3 (IQR: 2-8), p = 0.003), and discharging by ED physicians (documentation rate: 13.2% vs 42.6%, p < 0.001) were associated with poorer documentation of IFs only in abdominopelvic scans.
CONCLUSIONS: CT imaging in ED trauma patients often reveals incidental findings, especially in older patients. Over 50% of these findings are clinically significant, yet they are frequently ignored and not documented. Physicians need to be more vigilant in recognizing and documenting these incidental findings and informing patients of the need for further evaluation.
METHODS: This observational study was conducted at two urban level-1 trauma centers from March 2019 through April 2022. Official radiology reports of trauma patients who underwent chest and/or abdominopelvic CT scans at the emergency department (ED) were explored, and IF were extracted. Predictive factors of the presence of IFs and their documenting were investigated.
RESULTS: Out of 656 chest and 658 abdominopelvic CT scans, 167 (25.37%) and 212 (32.31%) scans harbored at least one IF, respectively. Patients with IFs tended to be of higher age and female in both chest (age: 48 [IQR: 35-62] vs. 34 [IQR: 25-42.5]; female: 31.14% vs 14.66%, p < 0.001 for both) and abdominopelvic CT scans (age: 41 [IQR: 30-57.5] vs 33 [IQR: 25-43], female: 26.42% vs. 13.96%, p < 0.001 for both). As for documentation of significant IFs, only 49 of 112 chest IFs (43.8%) and 55 of 176 abdominopelvic IFs (31.3%) were documented. Investigating factors associated with documentation of clinically significant IFs, shorter length of hospital stay (1.5 (IQR: 0-4) vs. 3 (IQR: 2-8), p = 0.003), and discharging by ED physicians (documentation rate: 13.2% vs 42.6%, p < 0.001) were associated with poorer documentation of IFs only in abdominopelvic scans.
CONCLUSIONS: CT imaging in ED trauma patients often reveals incidental findings, especially in older patients. Over 50% of these findings are clinically significant, yet they are frequently ignored and not documented. Physicians need to be more vigilant in recognizing and documenting these incidental findings and informing patients of the need for further evaluation.
摘要：
背景：成像可能无意中揭示与其表现目的无关的病理，称为偶然发现(IF)。这项研究旨在评估患病率，临床意义,创伤患者的胸部和腹骨盆计算机断层扫描（CT）扫描中的IFs文件。
方法：这项观察性研究于2019年3月至2022年4月在两个城市一级创伤中心进行。探讨了在急诊科（ED）接受胸部和/或腹骨盆CT扫描的创伤患者的官方放射学报告，并提取了IF。研究了IFs存在的预测因素及其记录。
结果：在656个胸部和658个腹骨盆CT扫描中，167（25.37％）和212（32.31％）扫描至少包含一个IF，分别。IFs患者的年龄往往较高，胸部均为女性（年龄：48[IQR：35-62]vs.34[IQR：25-42.5]；女性：31.14％vs14.66％，两者的p<0.001）和腹骨盆CT扫描（年龄：41[IQR：30-57.5]vs33[IQR：25-43]，女性：26.42%vs.13.96%,两者的p<0.001)。至于重要IF的文件，112例胸部IFs中仅有49例(43.8%)和176例腹骨盆IFs中的55例(31.3%)被记录.调查与临床重要IFs记录相关的因素，住院时间较短(1.5(IQR：0-4)与3（IQR：2-8），p=0.003),并由急诊医师出院(文件率：13.2%对42.6%，p<0.001）与仅在腹骨盆扫描中的IFs记录较差相关。
结论：ED创伤患者的CT成像通常会发现偶然发现，尤其是老年患者。这些发现中有超过50%具有临床意义，然而，他们经常被忽视，没有记录。医生需要更加警惕地识别和记录这些偶然发现，并告知患者需要进一步评估。
方法：这项观察性研究于2019年3月至2022年4月在两个城市一级创伤中心进行。探讨了在急诊科（ED）接受胸部和/或腹骨盆CT扫描的创伤患者的官方放射学报告，并提取了IF。研究了IFs存在的预测因素及其记录。
结果：在656个胸部和658个腹骨盆CT扫描中，167（25.37％）和212（32.31％）扫描至少包含一个IF，分别。IFs患者的年龄往往较高，胸部均为女性（年龄：48[IQR：35-62]vs.34[IQR：25-42.5]；女性：31.14％vs14.66％，两者的p<0.001）和腹骨盆CT扫描（年龄：41[IQR：30-57.5]vs33[IQR：25-43]，女性：26.42%vs.13.96%,两者的p<0.001)。至于重要IF的文件，112例胸部IFs中仅有49例(43.8%)和176例腹骨盆IFs中的55例(31.3%)被记录.调查与临床重要IFs记录相关的因素，住院时间较短(1.5(IQR：0-4)与3（IQR：2-8），p=0.003),并由急诊医师出院(文件率：13.2%对42.6%，p<0.001）与仅在腹骨盆扫描中的IFs记录较差相关。
结论：ED创伤患者的CT成像通常会发现偶然发现，尤其是老年患者。这些发现中有超过50%具有临床意义，然而，他们经常被忽视，没有记录。医生需要更加警惕地识别和记录这些偶然发现，并告知患者需要进一步评估。
