Citation

Smith LM, King SA, Shealy JA, Heidel RE, Morin-Ducote GI, Husband LD, Callison JC, Rosen BA, Savoy RA, Daley BJ. J. Am. Coll. Surg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2020.11.028

PMID

unavailable

Abstract

BACKGROUND: Incidental findings (IF) are reported in 20% or more of trauma CT scans. In addition to the importance of patient disclosure, there is significant legal pressure to avoid missed diagnoses. We reported previously 63.5% of IF were disclosed prior to discharge, with 20% non-disclosed. We initiated a multi-disciplinary systemic plan to effect pre-discharge disclosure by synoptic CT reports with American College of Radiology (ACR) recommended follow-up, EMR discharge prompts, and provider education. STUDY DESIGN: Prospective observational series patients from November 2019-February 2020. Statistical analysis performed with SPSS statistical package web version 21.

RESULTS: 877 patients (pts) with CT (507 males/370 females) Average age was 57 years (range: 14-99) and 96% had blunt injury. In 315 pts there were 523 IF (1.7 per pt.), the most common being lung (17.5%), kidney (13%) and liver (11%). Radiology report compliance was 210 of 249 (84%). There were 66 studies from outside facilities. Sixteen IF were suspicious for malignancy. A total of 151 pts needed no follow-up and 148 pts needed future follow-up evaluation. Pre-discharge IF disclosure compliance was 90.1% (286 patients), with 25 post-discharge. Four pts remain undisclosed. Compared to our previous report, clearer reporting and EMR prompts increased pre-discharge disclosure from 63.5% to 90.1% (p < 0.01, Chi-square test) and decreased days to notification from 29.5 (0-277) to 5.2 (range 0-59) (p < 0.01, Mann-Whitney U test.) CONCLUSION: Timely, complete disclosure of IF improves patient outcome and reduces medicolegal risk. Collaboration between trauma, radiology, and IT promotes improved disclosure in trauma populations.

Language: en

Keywords

Trauma; Prospective Studies; Disclosure; Missed Diagnosis; Patient Discharge; Radiography