Every major trauma patient undergoes some type of radiographic imaging during their initial evaluation. On occasion, some incidental finding unrelated to trauma shows up unexpectedly. These incidentalomas add several additional layers of complexity to the evaluation process.

What does the finding mean? Is it important? How do I tell the patient? Their primary care provider? When? Many times, these findings have little clinical significance. But on occasion, they can be life changing, such as the incidental renal cell carcinoma.

The group at University of Tennessee – Knoxville reviewed one year of incidental findings in trauma evaluations at their Level I trauma center. They specifically looked at diagnoses with malignant potential, and how findings were disclosed to the patient.

Here are the factoids:

• Over 6000 patients were reviewed, and 22% had 1222 incidental findings (that’s 2 per patient!)
• The findings were noted in males about 2/3 of the time
• 59% of of incidentalomas were in the chest, and 16% in the abdomen
• The most common findings were lung nodule (209), hernia (112), and renal cyst (103)
• Only 60% of patients were informed prior to discharge (!)
• Trauma registry abstraction resulted in an additional 20% of patients informed of the finding
• 58 patients could not be located, and in 43 patients there was no documented attempt to contact them
• An additional 100 registry charts that did not contain incidental findings were re-abstracted and searched for incidental findings. Nearly one third contained incidental findings!
• If the incidental finding was noted in the radiology report summary, 78% of patients were informed. But when it was buried in the body of the report, only 22% were disclosed.

Here are some questions for the authors and presenter to consider in advance to help them prepare for audience questions:

• The majority of the incidental findings were in the chest and abdomen. What and where were the rest?
• What would you recommend for achieving optimal disclosure based on your results? It appears that 20% or so of patients never learned of the finding.
• What should we do about our registry data? Should we force our registrars to comb all reports for possible incidental findings? Given that one fifth of patients have them (or more) that seems like a lot of work!
• How has your work changed your practice at UT Knoxville?

This is a fascinating paper, and gives me some ideas for upcoming blog posts! I will definitely be in the audience for this presentation.

Reference:  A novel use of the trauma registry: incidental findings in the trauma patient. EAST 2019, Quick Shot Paper #13.