Martin Lee David Gunn MBChB, Presenter: Medical Advisor, TransformativeMed, Inc Spouse, Consultant, Wolters Kluwer nv Grant, Koninklijke Philips NV

Meliha Yetisgen-Yildiz PhD, Abstract Co-Author: Nothing to Disclose

Thomas H Payne MD, Abstract Co-Author: Nothing to Disclose

Jonathan Seth Ilgen MD, Abstract Co-Author: Nothing to Disclose

Jamie Shandro MD, MPH, Abstract Co-Author: Nothing to Disclose

Bruce E. Lehnert MD, Abstract Co-Author: Nothing to Disclose

The proportion of the US population that is 65 years and older is growing rapidly. In 2012, 25% of injuries in the National Trauma Databank occurred in patients aged 65+ years, and by 2030 20% of the US population will be >65 years old. Imaging “incidentalomas” have been shown to be common and important CT findings. The purpose of this study was to evaluate the relationship between patient age and the incidence of major incidental findings on trauma CT scans.  

Retrospective, IRB approved and HIPAA compliant single-center study of all adult (18yrs+) patients who presented to an urban level 1 trauma center and underwent single phase CT of the chest-abdomen-and pelvis from Jan 1, 2013 to Dec 31, 2013 to evaluate for trauma. The definition of a major incidental finding (MIF) requiring communication was reached by consensus of two radiologists and three clinicians. All radiology reports were reviewed for major and minor incidental findings. Statistical analysis included a Mann-Whitney U and Fisher-exact tests to compare the patient ages in the major incidental and non-incidental groups.

In the 533 CT scans reviewed, 148 major incidental findings were identified in 132 patients (25%). The average age of patients without MIFs was 43 (sd=17.8) years, compared to 56 (sd=18.4) years in patients with incidental findings (p<0.0001). There was a steady increase in the major incidental rate each decade, peaking at age 80-90 years (r2 = 0.86). 42/95 (44.2%) of patients 65+ years had MIFs compared to 90/438 (20.6%) patients < 65 years (p<0.0001). MIFs were located in the chest: 80(54%), abdomen: 51(34.5%), pelvis: 14 (9.5%), and other: 1(0.7%). Pulmonary nodules were the most common incidental finding, being present in 38/533 (7.1%) of patients (average 57yrs; sd=14.4 yrs), and representing 25% of incidental findings.  

There is a strong correlation between patient age and the presence of major incidental findings on trauma torso CT.

Due to the progressively rising average population age, our findings of a higher rate of major incidental findings on CT in the elderly suggests the rate of incidental findings is likely to increase in coming years. Systems should to be developed to ensure adequate communication and follow-up of these findings.

Gunn, M, Yetisgen-Yildiz, M, Payne, T, Ilgen, J, Shandro, J, Lehnert, B, Major Incidental Findings on Trauma CT: Rate and Impact of Patient Age.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045611.html