Original Article

CME Article: Enhanced Notification of Radiographic Incidental Findings in Trauma Does Not Guarantee Follow-Up Compliance

Authors: Mary McCrory, MS, Lou Smith MD, Eric Heidel, PhD, Brian Daley, MD

Abstract

Objectives: Follow-up care for incidental findings (IFs) on trauma computed tomography scans is a component of comprehensive healthcare. Our objective was to assess the effectiveness of our IF predischarge disclosure practice guideline and identify factors contributing to follow-up failure.

Methods: This was a secondary analysis of a prospective observational database: 615 patients with IFs from November 2019 to February 2020. Follow-up compliance was determined by electronic medical record review and/or a telephone call after a mail-out request for voluntary participation. Volunteers answered a predetermined questionnaire regarding follow-up care.

Results: A total of 115 patients (19%) had computed tomography–based IFs recommending additional imaging or other follow-ups. Seventy-four (64%) patients were lost to inclusion as a result of death (12.1%), inability to contact (51.3%), or noninterest (5.2%). Of the remaining 36 patients, 19 received follow-up care (52.7%) and 17 did not (47.2%). No statistical differences existed among groups in age, sex, mechanism of injury, Glasgow Coma Scale score, whether informed by physicians or midlevel providers, or type of IF. A total of 15 (88%) nonfollow-up patients did not recall the disclosure or discharge paperwork instructions. Of 19 compliant patients: 9 had additional imaging only, 5 had biopsies and/or surgical intervention (n = 3 cancer, n = 2 benign), 3 had primary care advice against additional studies and 2 were referred to specialists.

Conclusions: Predischarge disclosure of IFs can contribute significantly to overall patient health. Nonetheless, fewer than half of patients do not pursue follow-up recommendations, most often citing failure to recall verbal/written instructions. More effective communication with attention to health literacy, follow-up telephone calls, and postdischarge appointments are potential catalysts for improved patient compliance.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Kapoor S, Deppen SA, Paulson AB, et al. Education level predicts appropriate follow-up of incidental findings from lung cancer screening. J Am Coll Radiol 2020;17:613–619.
 
2. Paluska TR, Sise MJ, Sack DI, et al. Incidental CT findings in trauma patients: incidence and implications for care of the injured. J Trauma 2007;62:157–161.
 
3. Smith LM, King SA, Shealy JA, et al. Incidental findings in the trauma population: interdisciplinary approach and electronic medical record reminder association with pre-discharge reporting and medicolegal risk. J Am Coll Surg 2021;232:380–385.e1.
 
4. Martin S, LoPolito A, Whitney LD, et al. Incidental findings protocol implementation at a level-I trauma center: a review of patient follow-up. Am Surg 2023;89:3174–3179.
 
5. James MK, Francois MP, Yoeli G, et al. Incidental findings in blunt trauma patients: prevalence, follow-up documentation, and risk factors. Emerg Radiol 2017;24:347–353.
 
6. Messersmith WA, Brown DFM, Barry MJ. The prevalence and implications of incidental findings on ED abdominal CT scans.Am J Emerg Med 2001;19:479–481.
 
7. Aaland MO, Marose K, Zhu TH. The lost to trauma patient follow-up: a system or patient problem. J Trauma Acute Care Surg 2012;73:1507–1511.