Original ContributionsThe prevalence and implications of incidental findings on ED abdominal CT scans*,**
Section snippets
Methods
We examined the reports of 321 consecutive abdominal CT scans ordered from our urban university hospital ED between April 1996 and June 1997 using a “renal stone” protocol of helical scanning without contrast. The reports were reviewed for the presence of incidental findings, which were subdivided into the level of concern for serious pathology they generated in the mind of a physician reading the report. Because of the expected wide variety of potential findings, three deliberately general
Results
The mean age of the study subjects was 43 (range 16-81); 64% were men and 67% had evidence of nephrolithiasis on CT. Of 321 reports, 14 were eliminated from further analysis because of either reviewer indicating they revealed alternative diagnoses, which included appendicitis, diverticulitis, and cholelithiasis. A high proportion (145/307) of the remaining reports contained at least one incidental finding, of which 51% raised “moderate” or “severe” concern in the mind of the first reviewer (Fig
Discussion
Incidental findings were common on ED abdominal helical CT scans obtained for suspected renal colic. We found that 45% of 321 scans had incidental findings, about half of which generated “moderate/severe” concern in the minds of 2 independent reviewers. Most of the findings, even when of “moderate/severe concern,” were not noted in the ED record and had no evidence of follow-up over a minimum of 2 years. In fact, in the 61 cases where both reviewers agreed there was at least moderate concern,
Acknowledgements
The authors would like to thank Steven Atlas, MD, for reviewing the Internal Review Board protocol and William Kormos, MD for reviewing the manuscript.
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Address reprint requests to Michael J. Barry, MD, Chief, General Medicine Unit, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114. E-mail: [email protected]
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