Incidental findings in brain CT scans of patients with head trauma
-
Marzieh Alinezhad
,
Fariba Alikhani
,
Fatemeh Bamarinejad
,
Aatefeh Bamarinejad
,
Fatemezahra Hosseinzadeh
Abstract
Objective: Incidental findings (IFs) are newly discovered abnormal findings unrelated to the primary purpose of imaging. Brain computed tomography (CT) scan is one of the most essential and initial imaging evaluations for head trauma patients, which may also have nontraumatic IFs. We aim to investigate the prevalence and nature of IFs in brain CT scans of head trauma patients.
Methods: We conducted a cross-sectional study to evaluate brain CT scans of 1006 head trauma patients over one year (April 2021 to March 2022), to identify incidental findings by consensus agreement of two radiologists. We categorized the incidental findings into four categories based on appropriate follow-up recommendations.
Results: We included 1006 head trauma patients who underwent brain CT scan, of which 126 incidental findings were discovered in brain CT scan of 107 patients. The prevalence of incidental findings was 10.6% (107/1006). The most common incidental finding was brain atrophy (n=15, 11.9%). The mean age of patients with IFs was significantly higher than those without IFs, but there was no difference between the two groups regarding gender.
Conclusion: The discovery rate of incidental findings of brain CT scans in head trauma patients was considerable. Serious medical findings that need immediate evaluation were found in 5.6% of patients, mostly over the age of 40. Therefore, patients who have clinically significant incidental findings need improved documentation and follow-up to evaluate the long-term outcomes and reliability of imaging results.
1. Evans CS, Arthur R, Kane M, Omofoye F, Chung AE, Moreton E, et al. Incidental radiology findings on computed tomography studies in emergency department patients: a systematic review and meta-analysis. Ann Emerg Med. 2022;80(3):243-56.
2. Treskes K, Bos SA, Beenen LFM, Sierink JC, Edwards MJR, Beuker BJA, et al. High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial. Eur Radiol. 2017;27:2451-62.
3. Lumbreras B, Donat L, Hernández-Aguado I. Incidental findings in imaging diagnostic tests: a systematic review. Br J Radiol. 2010;83(988):276-89.
4. Liu P-Y, Kuo L-W, Liao C-H, Hsieh C-H, Bajani F, Fu C-Y. Incidental findings on whole-body computed tomography in major trauma patients: who and what? Am Surg. 2022;88(7):1694-702.
5. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung Y-C, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018;130(4):1080-97.
6. Mutch CA, Talbott JF, Gean A. Imaging evaluation of acute traumatic brain injury. Neurosurg Clin. 2016;27(4):409-39.
7. Illes J. Brain screening and incidental findings: flocking to folly? Lancet Neurol. 2008;7(1):23-4.
8. Razavi-Ratki SK, Arefmanesh Z, Namiranian N, Gholami S, Sobhanardekani M, Moghadam AN, et al. CT scan incidental findings in head trauma patients-Yazd Shahid Rahnemoun Hospital, 2005–2015. Arch Iran Med. 2019;22(5):252-4.
9. Shoemaker JM, Holdsworth MT, Aine C, Calhoun VD, de La Garza R, Feldstein Ewing SW, et al. A practical approach to incidental findings in neuroimaging research. Neurology. 2011;77(24):2123-7.
10. Gibson LM, Nolan J, Littlejohns TJ, Mathieu E, Garratt S, Doherty N, et al. Factors associated with potentially serious incidental findings and with serious final diagnoses on multi-modal imaging in the UK biobank imaging study: a prospective cohort study. PLoS One. 2019;14(6):e0218267.
11. Sierink JC, Saltzherr TP, Russchen MJAM, de Castro SMM, Beenen LFM, Schep NWL, et al. Incidental findings on total-body CT scans in trauma patients. Injury. 2014;45(5):840-4.
12. Rogers AJ, Maher CO, Schunk JE, Quayle K, Jacobs E, Lichenstein R, et al. Incidental findings in children with blunt head trauma evaluated with cranial CT scans. Pediatrics. 2013;132(2):e356-63.
13. Li Y, Thompson WK, Reuter C, Nillo R, Jernigan T, Dale A, et al. Rates of incidental findings in brain magnetic resonance imaging in children. JAMA Neurol. 2021;78(5):578-87.
14. Munk M-D, Peitzman AB, Hostler DP, Wolfson AB. Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center. J Emerg Med. 2010;38(3):346-50.
15. 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 Acute Care Surg. 2007;62(1):157-61.
16. Fakler JKM, Özkurtul O, Josten C. Retrospective analysis of incidental non-trauma associated findings in severely injured patients identified by whole-body spiral CT scans. Patient Saf Surg. 2014;8(1):1-8.
17. Berge P, Darsonval A, Nedelcu C, Paisant A, Aubé C. Incidental findings on emergency CT scans: predictive factors and medico-economic impact. Eur J Radiol. 2020;129:109072.
18. Kroczek EK, Wieners G, Steffen I, Lindner T, Streitparth F, Hamm B, et al. Non-traumatic incidental findings in patients undergoing whole-body computed tomography at initial emergency admission. Emerg Med J. 2017;34(10):643-6.
19. James MK, Francois MP, Yoeli G, Doughlin GK, Lee S-W. Incidental findings in blunt trauma patients: prevalence, follow-up documentation, and risk factors. Emerg Radiol. 2017;24:34753.
20. Andrawes P, Picon AI, Shariff MA, Azab B, von Waagner W, Demissie S, et al. CT scan incidental findings in trauma patients: does it impact hospital length of stay? Trauma Surg acute care open. 2017;2(1):e000101.
21. Eskandary H, Sabba M, Khajehpour F, Eskandari M. Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol. 2005;63(6):550-3.
22. Boutet C, Vassal F, Celle S, Schneider FC, Barthelemy J-C, Laurent B, et al. Incidental findings on brain magnetic resonance imaging in the elderly: the PROOF study. Brain Imaging Behav. 2017;11(1):293-9.
23. Bos D, Poels MMF, Adams HHH, Akoudad S, Cremers LGM, Zonneveld HI, et al. Prevalence, clinical management, and natural course of incidental findings on brain MR images: the population-based Rotterdam scan study. Radiology. 2016;281(2):507-15.
24. Ruesseler M, Schill A, Lehnert T, Wyen H, Wutzler S, Marzi I, et al. Incidental findings in patients with multiple injuries: how to proceed? J Trauma Acute Care Surg. 2013;75(5):848-53.
25. Zener R, Johnson P, Wiseman D, Pandey S, Mujoomdar A. Informed consent for radiation in interventional radiology procedures. Can Assoc Radiol J. 2018;69(1):30-7.
26. O’Sullivan JW, Muntinga T, Grigg S, Ioannidis JPA. Prevalence and outcomes of incidental imaging findings: umbrella review. bmj. 2018;361.
27. Ganguli I, Simpkin AL, Lupo C, Weissman A, Mainor AJ, Orav EJ, et al. Cascades of care after incidental findings in a US national survey of physicians. JAMA Netw Open. 2019;2(10):e1913325.
28. Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 2010;7(10):754-73.
29. Gibson LM, Sellors J, Sudlow CLM. Management of incidental findings on multimodal imaging in UK biobank. Incidental Radiol Find. 2017;71-8.
30. Borra RJH, Sorensen AG. Incidental findings in brain MRI research: what do we owe our subjects? J Am Coll Radiol. 2011;8(12):848-52.
31. Nelson CA. Incidental findings in magnetic resonance imaging (MRI) brain research. J Law, Med Ethics. 2008;36(2):315-9.
2. Treskes K, Bos SA, Beenen LFM, Sierink JC, Edwards MJR, Beuker BJA, et al. High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial. Eur Radiol. 2017;27:2451-62.
3. Lumbreras B, Donat L, Hernández-Aguado I. Incidental findings in imaging diagnostic tests: a systematic review. Br J Radiol. 2010;83(988):276-89.
4. Liu P-Y, Kuo L-W, Liao C-H, Hsieh C-H, Bajani F, Fu C-Y. Incidental findings on whole-body computed tomography in major trauma patients: who and what? Am Surg. 2022;88(7):1694-702.
5. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung Y-C, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018;130(4):1080-97.
6. Mutch CA, Talbott JF, Gean A. Imaging evaluation of acute traumatic brain injury. Neurosurg Clin. 2016;27(4):409-39.
7. Illes J. Brain screening and incidental findings: flocking to folly? Lancet Neurol. 2008;7(1):23-4.
8. Razavi-Ratki SK, Arefmanesh Z, Namiranian N, Gholami S, Sobhanardekani M, Moghadam AN, et al. CT scan incidental findings in head trauma patients-Yazd Shahid Rahnemoun Hospital, 2005–2015. Arch Iran Med. 2019;22(5):252-4.
9. Shoemaker JM, Holdsworth MT, Aine C, Calhoun VD, de La Garza R, Feldstein Ewing SW, et al. A practical approach to incidental findings in neuroimaging research. Neurology. 2011;77(24):2123-7.
10. Gibson LM, Nolan J, Littlejohns TJ, Mathieu E, Garratt S, Doherty N, et al. Factors associated with potentially serious incidental findings and with serious final diagnoses on multi-modal imaging in the UK biobank imaging study: a prospective cohort study. PLoS One. 2019;14(6):e0218267.
11. Sierink JC, Saltzherr TP, Russchen MJAM, de Castro SMM, Beenen LFM, Schep NWL, et al. Incidental findings on total-body CT scans in trauma patients. Injury. 2014;45(5):840-4.
12. Rogers AJ, Maher CO, Schunk JE, Quayle K, Jacobs E, Lichenstein R, et al. Incidental findings in children with blunt head trauma evaluated with cranial CT scans. Pediatrics. 2013;132(2):e356-63.
13. Li Y, Thompson WK, Reuter C, Nillo R, Jernigan T, Dale A, et al. Rates of incidental findings in brain magnetic resonance imaging in children. JAMA Neurol. 2021;78(5):578-87.
14. Munk M-D, Peitzman AB, Hostler DP, Wolfson AB. Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center. J Emerg Med. 2010;38(3):346-50.
15. 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 Acute Care Surg. 2007;62(1):157-61.
16. Fakler JKM, Özkurtul O, Josten C. Retrospective analysis of incidental non-trauma associated findings in severely injured patients identified by whole-body spiral CT scans. Patient Saf Surg. 2014;8(1):1-8.
17. Berge P, Darsonval A, Nedelcu C, Paisant A, Aubé C. Incidental findings on emergency CT scans: predictive factors and medico-economic impact. Eur J Radiol. 2020;129:109072.
18. Kroczek EK, Wieners G, Steffen I, Lindner T, Streitparth F, Hamm B, et al. Non-traumatic incidental findings in patients undergoing whole-body computed tomography at initial emergency admission. Emerg Med J. 2017;34(10):643-6.
19. James MK, Francois MP, Yoeli G, Doughlin GK, Lee S-W. Incidental findings in blunt trauma patients: prevalence, follow-up documentation, and risk factors. Emerg Radiol. 2017;24:34753.
20. Andrawes P, Picon AI, Shariff MA, Azab B, von Waagner W, Demissie S, et al. CT scan incidental findings in trauma patients: does it impact hospital length of stay? Trauma Surg acute care open. 2017;2(1):e000101.
21. Eskandary H, Sabba M, Khajehpour F, Eskandari M. Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol. 2005;63(6):550-3.
22. Boutet C, Vassal F, Celle S, Schneider FC, Barthelemy J-C, Laurent B, et al. Incidental findings on brain magnetic resonance imaging in the elderly: the PROOF study. Brain Imaging Behav. 2017;11(1):293-9.
23. Bos D, Poels MMF, Adams HHH, Akoudad S, Cremers LGM, Zonneveld HI, et al. Prevalence, clinical management, and natural course of incidental findings on brain MR images: the population-based Rotterdam scan study. Radiology. 2016;281(2):507-15.
24. Ruesseler M, Schill A, Lehnert T, Wyen H, Wutzler S, Marzi I, et al. Incidental findings in patients with multiple injuries: how to proceed? J Trauma Acute Care Surg. 2013;75(5):848-53.
25. Zener R, Johnson P, Wiseman D, Pandey S, Mujoomdar A. Informed consent for radiation in interventional radiology procedures. Can Assoc Radiol J. 2018;69(1):30-7.
26. O’Sullivan JW, Muntinga T, Grigg S, Ioannidis JPA. Prevalence and outcomes of incidental imaging findings: umbrella review. bmj. 2018;361.
27. Ganguli I, Simpkin AL, Lupo C, Weissman A, Mainor AJ, Orav EJ, et al. Cascades of care after incidental findings in a US national survey of physicians. JAMA Netw Open. 2019;2(10):e1913325.
28. Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 2010;7(10):754-73.
29. Gibson LM, Sellors J, Sudlow CLM. Management of incidental findings on multimodal imaging in UK biobank. Incidental Radiol Find. 2017;71-8.
30. Borra RJH, Sorensen AG. Incidental findings in brain MRI research: what do we owe our subjects? J Am Coll Radiol. 2011;8(12):848-52.
31. Nelson CA. Incidental findings in magnetic resonance imaging (MRI) brain research. J Law, Med Ethics. 2008;36(2):315-9.
| Files | ||
| Issue | Vol 8 No 2 (2024): Spring (April) | |
| Section | Original article | |
| DOI | 10.18502/fem.v8i2.15464 | |
| Keywords | ||
| Computed Tomography Head Trauma Incidental Finding | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Alinezhad M, Alikhani F, Bamarinejad F, Bamarinejad A, Hosseinzadeh F. Incidental findings in brain CT scans of patients with head trauma. Front Emerg Med. 2024;8(2):e16.
Downloads
Download data is not yet available.
