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Non-traumatic incidental findings in patients undergoing whole-body computed tomography at initial emergency admission
  1. Eduard K Kroczek1,2,
  2. Gero Wieners1,
  3. Ingo Steffen1,
  4. Tobias Lindner3,
  5. Florian Streitparth1,
  6. Bernd Hamm1,
  7. Martin H Maurer1,4
  1. 1 Department of Radiology, Charité – University Medicine Berlin, Berlin, Germany
  2. 2 Department for Diagnostic and Interventional Neuroradiology, University Medical Centre Göttingen, Göttingen, Germany
  3. 3 Department of Emergency Medicine, Charité – University Medicine Berlin, Berlin, Germany
  4. 4 Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Martin H Maurer, Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland; martin.maurer{at}insel.ch

Abstract

Objective To evaluate the number, localisation and importance of non-traumatic incidental findings (IFs) in patients with suspected or obvious multiple trauma undergoing whole-body CT (WBCT) in a level-1 trauma centre.

Methods Between January 2009 and December 2013, a total of 2440 patients with trauma undergoing WBCT at admission to a level-1 trauma centre of a university hospital were retrospectively analysed, through imaging IFs unrelated to trauma with the radiological reports. All IFs were grouped into four categories according to their clinical relevance. Category 1: urgent treatment or further clarification needed; category 2: further examination and follow-up within 3–6 months required; category 3: findings with no immediate consequences for the treatment of the patient but of potential relevance in the future; category 4: harmless findings.

Results Altogether, 5440 IFs in 2440 patients (1735 male, 705 female; mean age 45.1 years) were documented. In 204 patients (8.4%) urgent category 1 findings were reported, 766 patients (31.4%) had category 2 findings, 1236 patients (50.7%) had category 3 findings and 1173 patients (48.1%) had category 4 findings. Most IFs were detected in the abdomen/pelvis (42.5%). 602 (24.7%) of the patients had no IFs.

Conclusions WBCT scans of unrelated trauma patients demonstrate a high rate of IF. A substantial percentage (8.4%) of patients had urgent category 1IFs and a high percentage (31.4%) had category 2 IFs requiring a follow-up. This high number of patients with polytrauma undergoing WBCT, having IFs of high relevance, poses a major challenge for the level-1 trauma centre in the acute and postacute management of these patients.

  • imaging
  • CT/MRI
  • non-traumatic problems
  • emergency department management
  • major incidents
  • epidemiology
  • major trauma management

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