Incidental findings on trauma CT
Incidental findings on trauma CT are defined as findings unrelated to the specific mechanism of injury.
They are reported to be present in 55-75% of patients, with most being within the abdomen and pelvis 1. As the use of whole body CT for trauma increases, there is an associated increase in the detection of incidental findings. An additional contributory factor is the rising use of trauma CT in older patients in whom there is a higher background prevalence of undetected but significant pathology 3,4. These factors feed into an ongoing debate around the costs of trauma imaging versus the benefits delivered, with the costs associated with incidental findings often being cited as a reason to consider the need for whole body CT more carefully.
40-60% of patients will have incidental findings that require no further imaging or intervention, such as simple renal or liver cysts. However, 40-60% will require either immediate or urgent investigation and/or treatment. These are typically malignancies or vascular diseases such as abdominal aortic aneurysms.
It should be remembered that for many incidental findings, further investigation and treatment may be outside of the scope of the trauma team so an attempt should be made to describe the degree of importance and significance of the findings.
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- 2. Sierink JC, Saltzherr TP, Russchen MJ, de Castro SM, Beenen LF, Schep NW, Goslings JC. Incidental findings on total-body CT scans in trauma patients. Injury. 45 (5): 840-4. doi:10.1016/j.injury.2013.10.009 - Pubmed
- 3. Seah MK, Murphy CG, McDonald S, Carrothers A. Incidental findings on whole-body trauma computed tomography: Experience at a major trauma centre. Injury. 47 (3): 691-4. doi:10.1016/j.injury.2016.01.012 - Pubmed
- 4. Taylor JV, Chawla S, Merrick E. Re: Incidental Findings on Whole-body Computed Tomography. Injury 2016;47(March (3)): 691-694. Injury. 47 (8): 1872. doi:10.1016/j.injury.2016.05.045 - Pubmed
- 5. Munden RF, Carter BW, Chiles C, MacMahon H, Black WC, Ko JP, McAdams HP, Rossi SE, Leung AN, Boiselle PM, Kent MS, Brown K, Dyer DS, Hartman TE, Goodman EM, Naidich DP, Kazerooni EA, Berland LL, Pandharipande PV. Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee. (2018) Journal of the American College of Radiology : JACR. 15 (8): 1087-1096. doi:10.1016/j.jacr.2018.04.029 - Pubmed