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. 2015 Feb 4;9(1):1.
doi: 10.1186/s13032-014-0022-x. eCollection 2015.

Improving patient notification of solid abdominal viscera incidental findings with a standardized protocol

Courtney E Collins  1 , Nicole Cherng  1 , Theodore McDade  1 , Babak Movahedi  1 , Timothy A Emhoff  1 , Giles F Whalen  1 , Jennifer LaFemina  1 , Jon D Dorfman  1
Affiliations

Improving patient notification of solid abdominal viscera incidental findings with a standardized protocol

Courtney E Collins et al. J Trauma Manag Outcomes. .

Abstract

Background: The increasing use of computed tomography (CT) scans in the evaluation of trauma patients has led to increased detection of incidental radiologic findings. Incidental findings (IFs) of the abdominal viscera are among the most commonly discovered lesions and can carry a risk of malignancy. Despite this, patient notification regarding these findings is often inadequate.

Methods: We identified patients who underwent abdominopelvic CTs as part of their trauma evaluation during a recent 1-year period (9/2011-8/2012). Patients with IFs of the kidneys, liver, adrenal glands, pancreas and/or ovaries had their charts reviewed for documentation of the lesion in their discharge paperwork or follow-up. A quality improvement project was initiated where patients with abdominal IFs were verbally informed of the finding, it was noted on their discharge summary and/or were referred to specialists for evaluation. Nine months after the implementation of the IF protocol, a second chart review was performed to determine if the rate of patient notification improved.

Results: Of 1,117 trauma patients undergoing abdominopelvic CT scans during the 21 month study period, 239 patients (21.4%) had 292 incidental abdominal findings. Renal lesions were the most common (146 patients, 13% of all patients) followed by hepatic (95/8.4%) and adrenal (38/3.4%) lesions. Pancreatic (10/0.9%) and ovarian lesions (3/0.3%) were uncommon. Post-IF protocol implementation patient notification regarding IFs improved by over 80% (32.4% vs. 17.7% pre-protocol, p = 0.02).

Conclusion: IFs of the solid abdominal organs are common in trauma patients undergoing abdominopelvic CT scan. Patient notification regarding these lesions is often inadequate. A systematic approach to the documentation and evaluation of incidental radiologic findings can significantly improve the rate of patient notification.

Keywords: Abdominal CT; Computed tomography; Incidental finding; Quality improvement; Trauma.

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References

    1. Fernandez-del Castillo C, Targarona J, Thayer SP, Rattner DW, Brugge W, Warshaw AL. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg. 2003;138(4):427–423. doi: 10.1001/archsurg.138.4.427. - DOI - PMC - PubMed
    1. Bulow B, Jansson S, Juhlin C, Steen L, Thoren M, Wahrenberg H, Valdemarsson S, Wangberg B, Ahren B. Adrenal incidentaloma - follow-up results from a Swedish prospective study. Eur J Endocrinol. 2006;154(3):419–23. doi: 10.1530/eje.1.02110. - DOI - PubMed
    1. Lahat G, Ben Haim M, Nachmany J, Sever R, Blachar A, Nakache R, Klausner JM. Pancreatic incidentalomas: high rate of potentially malignant tumors. J Am Coll Surg. 2009;209(3):313–9. doi: 10.1016/j.jamcollsurg.2009.05.009. - DOI - PubMed
    1. O’Connor SD, Pickhardt PJ, Kim DH, Oliva MR, Silverman SG. Incidental finding of renal masses at unenhanced CT: prevalence and analysis of features for guiding management. AJR Am J Roentgenol. 2011;197(1):139–45. doi: 10.2214/AJR.10.5920. - DOI - PubMed
    1. Paluska TR, Sise MJ, Sack DI, Sise CB, Egan MC, Biondi M. Incidental CT findings in trauma patients: incidence and implications for care of the injured. J Trauma. 2007;62(1):157–61. doi: 10.1097/01.ta.0000249129.63550.cc. - DOI - PubMed

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