Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis - 20/08/22
, Rodney Arthur, BS c, Michael Kane, MD a, d, Fola Omofoye, BS c, Arlene E. Chung, MD, MHA, MMCi, FAMIA a, g, Elizabeth Moreton, MLS e, Carlton Moore, MD, MS a, fAbstract |
Study objective |
An incidental finding is defined as a newly discovered mass or lesion detected on imaging performed for an unrelated reason. The identification of an incidental finding may be an opportunity for the early detection of a serious medical condition, including a malignancy. However, little is known about the prevalence of incidental findings in the emergency department (ED) setting and the strategies that can be used to mitigate the risk associated with them in the ED. This study aimed to estimate the overall prevalence of incidental findings and to summarize the currently described measures to mitigate the risks associated with incidental findings.
Methods |
On November 22, 2020, a systematic literature search of PubMed, EMBASE, and Scopus was performed for studies that were published in peer-reviewed journals and reported the prevalence of incidental findings in computed tomography (CT) scans in patients in the ED. Patients who received CT scans that included the head, neck, chest, or abdomen/pelvis were included. The study characteristics, overall prevalence of incidental findings, prevalence of incidental findings by body region, and prespecified subgroups were extracted. The criteria used for risk stratification within individual studies were also extracted. Pooled estimates were calculated using a random-effects meta-analysis.
Results |
A total of 1,385 studies were identified, and 69 studies met the inclusion criteria. The included studies represented 147,763 ED encounters or radiology reports across 16 countries, and 83% of studies were observational, cross-sectional studies. A total of 35 studies (50.7%) were in trauma patients. A large degree of heterogeneity was observed across the included studies. The overall pooled prevalence estimate for any incidental finding was 31.3% (95% confidence interval 24.4% to 39.1%). We found great variation in the methods described to mitigate the risk associated with incidental findings, including a lack of standardized risk stratification, inconsistent documentation practices, and only a small subset of studies describing prospective interventions aimed at improving the recognition and management of incidental findings from the ED.
Conclusion |
In patients in the ED receiving CT scans, incidental findings are commonly encountered across a broad range of ED chief complaints. This review highlights the existence of great heterogeneity in the definitions used to classify incidental findings. Future studies are needed to determine a clinically feasible categorization standard or terminology for commonly encountered incidental findings in the ED setting to standardize classification and documentation.
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| Please see page 244 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Allan B. Wolfson, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: CSE designed study, performed data abstraction/review, analyzed data, drafted and revised the manuscript. RA, MK, FO helped with data abstraction, study review, drafting and revising manuscript. AE, EM, and CM helped with study design, literature review methods, interpretation of results, and revising manuscript. CSE takes responsbility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. The authors report this article did not receive any outside funding or support. |
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| Trial registration number: PROSPERO registry (CRD420202226793). |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 80 - N° 3
P. 243-256 - septembre 2022 Retour au numéro
Article précédent
- Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings
- Tyler W. Barrett, Nicholas M. Garland, Clifford L. Freeman, Katharine Klar, Jan Dahlke, Penny Lancaster, Larry Prisco, Sam S. Chang, Laura W. Goff, Stephan Russ, Ian D. Jones
- Follow-up of Incidental Radiology Findings: Is the Cart Ahead of the Horse?
- Charissa B. Pacella, Donald M. Yealy
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