Incidental Findings in Trauma Patients: Dedicated Communication with the Primary Care Physician Ensures Adequate Follow-Up
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- Yeh, D.D., Imam, A.M., Truong, S.H. et al. World J Surg (2013) 37: 2081. doi:10.1007/s00268-013-2092-8
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Frequent use of computed tomography (CT) in trauma patients results in frequent detection of non-trauma-related incidental findings (IFs). Inpatient documentation and disclosure at discharge are infrequent, even when they are potentially serious. We aimed to not only identify the incidence of IFs but also to evaluate the effectiveness of an intervention to trigger follow-up.
In this before–after study, all trauma patients evaluated by the trauma surgery service who underwent CT were admitted for >24 h, had at least one IF requiring follow-up, and had a primary care physician (PCP) employed in our health care system were identified. The historical control period was from January 2006 to December 2008. The intervention period was from December 2011 to September 2012. Intervention consisted of notifying the PCP via email or postal letter. The outcome of interest—the rate of follow-up—was compared between both groups.
During the historical period, 364 (20.5 %) of 1,774 eligible trauma patients had 434 IFs requiring follow-up. During the study period, 197 (26 %) of 692 trauma patients had 212 IFs requiring follow-up. Overall, 91 % of study patients with postdischarge PCP follow-up had documented follow-up of the IF. There was a significant improvement in the rate of follow-up in the study group compared to that of the control group (51 vs. 11 %; p < 0.0001).
Detection of IFs is common in trauma patients. A dedicated effort of communicating the presence of an IF to the patient’s PCP triggered a follow-up for 91 % of patients who saw their PCP after hospital discharge.