European Radiology

, Volume 29, Issue 12, pp 6772–6779 | Cite as

Incidental findings in thoracic CTs performed in trauma patients: an underestimated problem

  • Eduardo J. Mortani BarbosaJrEmail author
  • Oladayo Osuntokun
Emergency Radiology



Whole-body CT scans are commonly performed to assess trauma patients, and often reveal incidental findings (IFs) the patient may be unaware of. We assessed the prevalence, associations, and adequacy of follow-up of IFs.


We retrospectively identified 1113 patients who had a chest CT to assess for traumatic injuries (6-year interval). We coded the radiology reports for IFs and queried our EMR regarding clinical history and adherence to follow-up recommendations for IFs mentioned in the reports.


IFs are much more likely (62.2%) to be found in a chest CT scan than acute traumatic injuries (ATI, 32.4%), in patients being evaluated for potential traumatic injuries. A total of 86.4% of patients who had IFs also had another relevant ICD-10 diagnosis (RD). Lung nodules were the most common IF (45.7%). A multivariate logistic regression model (MLR) demonstrated an accuracy of 89% to predict IFs; the 3 statistically significant predictors (p < 0.05) were any RD (FDR logworth 68.6), followed by smoking history (29.8) and age (4.1). Radiologists recommended follow-up for IF 53.5% of the time, but only 13.9% of patients ever received a follow-up imaging exam or invasive procedure.


IFs are much more common than ATI and can be accurately predicted based on MLR utilizing only 3 clinical variables. While radiologists often recommend follow-up for IFs in trauma patients, most are never effectively followed up or addressed, leading to increased risk of poor outcomes. Clinicians should be aware of the high prevalence of IFs and develop systems for appropriate, evidence-based recommendations, and effective management.

Key Points

• Incidental findings (IFs) are much more common (2×) than acute traumatic injuries (ATI) in chest CTs performed in trauma patients.

• IFs can be accurately predicted via logistic regression modeling with only 3 variables (any relevant ICD-10 diagnosis; positive smoking history; age), which may help radiologist to focus their attention on higher risk patients.

• Radiologists recommend follow-up for IFs more than half of the time; however, IFs are seldom followed up appropriately (less than 14%), leading to missed opportunities and potentially poor patient outcomes.


Incidental findings Tomography Trauma center Patient compliance 



Acute traumatic injuries


Electronic medical record




Health Insurance Portability and Accountability Act


International Classification of Diseases, 10th edition


Incidental findings


Institutional Review Board


Multivariate logistic regression


National Institutes of Health


Negative predictive value


Positive predictive value


Relevant diagnosis


Whole-body CT



This research has been accepted as an oral scientific presentation and presented at the prestigious European Congress of Radiology 2019 (Vienna, Feb 27–Mar 3), control # 5176, SS 717, Feb 28 2019.


This study has received funding by the National Heart, Lung and Blood Institute, National Institutes of Health, through grant R25-HL084665 (Oladayo Osuntokun). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with ethical standards


The scientific guarantor of this publication is Eduardo J. Mortani Barbosa Jr., MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (EB) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution


  1. 1.
    Centers for Disease Control and Prevention, National Center for Injury Prevention and Control Accessed online March 12, 2019
  2. 2.
    Hajibandeh S, Hajibandeh S (2015) Systematic review: effect of whole-body computed tomography on mortality in trauma patients. J Inj Violence Res 7(2):64–74PubMedPubMedCentralGoogle Scholar
  3. 3.
    Hansen CK, Strayer RJ, Shy BD, Kessler S, Givre S, Shah KH (2018) Prevalence of negative CT scans in a level one trauma center. Eur J Trauma Emerg Surg 44(1):29–33CrossRefGoogle Scholar
  4. 4.
    Messersmith WA, Brown DF, Barry MJ (2001) The prevalence and implications of incidental findings on ED abdominal CT scans. Am J Emerg Med 19(6):479–481CrossRefGoogle Scholar
  5. 5.
    Paluska TR, Sise MJ, Sack DI, Sise CB, Egan MC, Biondi M (2007) Incidental CT findings in trauma patients: incidence and implications for care of the injured. J Trauma 62(1):157–161Google Scholar
  6. 6.
    Seah MK, Murphy CG, Mcdonald S, Carrothers A (2016) Incidental findings on whole-body trauma computed tomography: experience at a major trauma centre. Injury 47(3):691–694CrossRefGoogle Scholar
  7. 7.
    Sierink J, Saltzherr T, Russchen M et al (2014) Incidental findings on total-body CT scans in trauma patients. Injury 45(5):840–844Google Scholar
  8. 8.
    Barrett TW, Schierling M, Zhou C et al (2009) Prevalence of incidental findings in trauma patients detected by computed tomography imaging. Am J Emerg Med 27(4):428–435Google Scholar
  9. 9.
    Baugh KA, Weireter LJ, Collins JN (2014) The trauma pan scan: what else do you find? Am Surg 80(9):855–859PubMedGoogle Scholar
  10. 10.
    Hoffstetter P, Herold T, Daneschnejad M et al (2008) Non-trauma-associated additional findings in whole-body CT examinations in patients with multiple trauma. Rofo 180(2):120–126Google Scholar
  11. 11.
    Thompson RJ, Wojcik SM, Grant WD, Ko PY (2011) Incidental findings on CT scans in the emergency department. Emerg Med Int 2011:624847.
  12. 12.
    Treskes K, Bos SA, Beenen LFM et al (2017) High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial. Eur Radiol 27(6):2451–2462. CrossRefPubMedGoogle Scholar
  13. 13.
    Treskes K, Bos SA, Beenen LFM et al (2016) Erratum to: high rates of clinically relevant incidental findings by total-body CT scanning in trauma patients: results of the REACT-2 trial. Eur Radiol 27(6):2463.
  14. 14.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381CrossRefGoogle Scholar
  15. 15.
    Munk Munk MD, Peitzman AB, Hostler DP, Wolfson AB (2010) Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center. J Emerg Med 38(3):346–350Google Scholar
  16. 16.
    James MK, Francois MP, Yoeli G, Doughlin GK, Lee SW (2017) Incidental findings in blunt trauma patients: prevalence, follow-up documentation, and risk factors. Emerg Radiol 24(4):347–353CrossRefGoogle Scholar
  17. 17.
    Sich N, Rogers A, Bertozzi D et al (2018) Filling the void: a low-cost, high-yield approach to addressing incidental findings in trauma patients. Surgery 163(4):657–660Google Scholar
  18. 18.
    Baccei SJ, Chinai SA, Reznek M, Henderson S, Reynolds K, Brush DE (2018) System-level process change improves communication and follow-up for emergency department patients with incidental radiology findings. J Am Coll Radiol 15(4):639–647CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Eduardo J. Mortani BarbosaJr
    • 1
    Email author
  • Oladayo Osuntokun
    • 1
  1. 1.Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations