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Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis.

Publication ,  Journal Article
Evans, CS; Arthur, R; Kane, M; Omofoye, F; Chung, AE; Moreton, E; Moore, C
Published in: Ann Emerg Med
September 2022

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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Published In

Ann Emerg Med

DOI

EISSN

1097-6760

Publication Date

September 2022

Volume

80

Issue

3

Start / End Page

243 / 256

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Radiology
  • Prospective Studies
  • Incidental Findings
  • Humans
  • Emergency Service, Hospital
  • Emergency & Critical Care Medicine
  • Cross-Sectional Studies
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Evans, C. S., Arthur, R., Kane, M., Omofoye, F., Chung, A. E., Moreton, E., & Moore, C. (2022). Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis. Ann Emerg Med, 80(3), 243–256. https://doi.org/10.1016/j.annemergmed.2022.03.027
Evans, Christopher S., Rodney Arthur, Michael Kane, Fola Omofoye, Arlene E. Chung, Elizabeth Moreton, and Carlton Moore. “Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis.Ann Emerg Med 80, no. 3 (September 2022): 243–56. https://doi.org/10.1016/j.annemergmed.2022.03.027.
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 Sep;80(3):243–56.
Evans, Christopher S., et al. “Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis.Ann Emerg Med, vol. 80, no. 3, Sept. 2022, pp. 243–56. Pubmed, doi:10.1016/j.annemergmed.2022.03.027.
Evans CS, Arthur R, Kane M, Omofoye F, Chung AE, Moreton E, Moore C. Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2022 Sep;80(3):243–256.
Journal cover image

Published In

Ann Emerg Med

DOI

EISSN

1097-6760

Publication Date

September 2022

Volume

80

Issue

3

Start / End Page

243 / 256

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Radiology
  • Prospective Studies
  • Incidental Findings
  • Humans
  • Emergency Service, Hospital
  • Emergency & Critical Care Medicine
  • Cross-Sectional Studies
  • 3202 Clinical sciences
  • 1103 Clinical Sciences