Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
EDITORIAL  
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 75-76
What's new in emergencies, trauma and shock? Need for a greater debate on "Incidental cranial computed tomography findings"


Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Click here for correspondence address and email

Date of Submission12-Apr-2015
Date of Acceptance12-Apr-2015
Date of Web Publication21-Apr-2015
 

How to cite this article:
Agrawal A. What's new in emergencies, trauma and shock? Need for a greater debate on "Incidental cranial computed tomography findings". J Emerg Trauma Shock 2015;8:75-6

How to cite this URL:
Agrawal A. What's new in emergencies, trauma and shock? Need for a greater debate on "Incidental cranial computed tomography findings". J Emerg Trauma Shock [serial online] 2015 [cited 2019 Jul 23];8:75-6. Available from: http://www.onlinejets.org/text.asp?2015/8/2/75/155498


Incidental findings on computed tomography (CT) scan are defined as "findings unrelated to the chief complaint and not pertinent to the immediate patient care in the Emergency Department." [1] A number of studies report the incidental findings on CT scan in patients (adults as well as children) who attended Emergency Department for trauma-related care (with or without traumatic brain injury [TBI]). [1],[2],[3] The findings may range from benign calcification (needs no intervention), some lesions may need regular follow up and a small number of the lesions may need urgent intervention (i.e., brain tumors). [1],[4],[5],[6],[7],[8]

There is wide variation in the reported incidence of incidental findings mainly reflecting the nonuniformity in inclusion/exclusion criteria defining the different lesions that are visible on CT scan. [3],[4],[5],[6],[9] For example in a study, the authors did not include sinus disease (as fractures of the sinus wall can cause bleeding and simulate a sinus disease) [2],[8] yet in another study apart from many other exclusion criteria the authors excluded age-related cerebral atrophy. [10] In contrary to this few studies (as well as a present study) included brain atrophy and sinus disease in their analysis. [2],[11] Another very important fact that has not been studied and reported in greater details is "some incidental findings might have actually predisposed to TBI." [8]

The present article [12] is yet another step to understand the incidence of incidental findings and the fact that "the article is from a resource poor setting" make this a unique and important contribution to the existing knowledge. Apart from this, the present study reflects that presently literature does not have consistent or uniform guidelines to address many issues in context of incidental findings on imaging including:

  • How to define incidental findings?
  • How to categorize incidental findings?
  • How to further investigate or manage these cases?
  • How to further follow up these cases? and
  • How to and how much to be disclosed to the patient and/or relatives?


 
   References Top

1.
Thompson RJ, Wojcik SM, Grant WD, Ko PY. Incidental Findings on CT Scans in the Emergency Department. Emerg Med Int 2011; 2011:624847.  Back to cited text no. 1
    
2.
Rogers AJ, Maher CO, Schunk JE, Quayle K, Jacobs E, Lichenstein R, et al. Incidental findings in children with blunt head trauma evaluated with cranial CT scans. Pediatrics 2013;132:e356-63.  Back to cited text no. 2
[PUBMED]    
3.
Illes J, Kirschen MP, Edwards E, Stanford LR, Bandettini P, Cho MK, et al. Ethics. Incidental findings in brain imaging research. Science 2006;311:783-4.  Back to cited text no. 3
    
4.
Taheri MS, Hemadi H, Nasab MS, Jalali AH, Eftekharpour D. Evaluation of incidental findings in brain CT scans of mild head trauma patients (GCS: Thirteen to Fifteen). Iran J Cancer Prev 2012;3:32-5.  Back to cited text no. 4
    
5.
Eskandary H, Sabba M, Khajehpour F, Eskandari M. Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol 2005;63:550-3.  Back to cited text no. 5
    
6.
Ortega HW, Vander Velden H, Reid S. Incidental findings on computed tomography scans in children with mild head trauma. Clin Pediatr (Phila) 2012;51:872-6.  Back to cited text no. 6
    
7.
Green DE, Woodward PJ. The management of indeterminate incidental findings detected at abdominal CT. Semin Ultrasound CT MR 2005;26:2-13.  Back to cited text no. 7
    
8.
Ibukun O, Salman Y, Olayori J. Incidental findings on computed tomographic scans in patients with head trauma in Ilorin, Nigeria. West Afr J Radiol 2014;21:75.  Back to cited text no. 8
  Medknow Journal  
9.
Munk MD, Peitzman AB, Hostler DP, Wolfson AB. Frequency and follow-up of incidental findings on trauma computed tomography scans: Experience at a level one trauma center. J Emerg Med 2010; 38:346-50.  Back to cited text no. 9
    
10.
Fakler JK, Ozkurtul O, Josten C. Retrospective analysis of incidental non-trauma associated findings in severely injured patients identified by whole-body spiral CT scans. Patient Saf Surg 2014;8:36.  Back to cited text no. 10
    
11.
Bordignon KC, Arruda WO. CT scan findings in mild head trauma: A series of 2,000 patients. Arq Neuropsiquiatr 2002;60:204-10.  Back to cited text no. 11
    
12.
Ogbole GI, Adeleye AO, Owolabi MO, Olatunji RB, Yusuf BP. Incidental cranial CT findings in head injury patients in a Nigerian tertiary hospital. J Emerg Trauma Shock 2015;8:77-82.  Back to cited text no. 12
  Medknow Journal  

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Correspondence Address:
Dr. Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.155498

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