Advertisement

Prevalence, documentation, and communication of incidental findings in focused assessment with sonography for trauma (FAST) examinations

Published:November 28, 2019DOI:https://doi.org/10.1016/j.ajem.2019.11.040

      Abstract

      Background

      As the focused assessment with sonography for trauma (FAST) examination becomes increasingly ubiquitous in the emergency department (ED), a parallel increase in incidental findings can also be expected. The purpose of this study was to determine the prevalence, documentation, and communication of incidental findings on emergency physician-performed FAST examinations.

      Methods

      Retrospective review at two academic EDs. Adult trauma patients undergoing FAST examinations used for clinical decision-making at the bedside were identified from an ED ultrasound image archival system. Expert sonologists reviewed ultrasound images for incidental findings, as well as electronic medical records for demographic information, mechanism of injury, type of incidental findings, documentation of incidental findings, and communication of incidental findings to the patient.

      Results

      A total of 1,452 FAST examinations were reviewed. One hundred and thirty-seven patients with incidental findings were identified (9.4%); 7 patients had an additional incidental finding. Renal cysts were most common (49/144, 34.0%), followed by pelvic cysts in women (32/144, 22.2%). While 31/144 (21.5%) incidental findings were identified and documented in the ultrasound reports or medical records by ED providers, only 6/137 (4.4%) patients were noted to be informed of their incidental findings.

      Conclusion

      Incidental findings were often encountered in FAST examinations, with cysts of the kidneys and pelvis being the most common findings. A vast majority of incidental findings were not documented or noted to be communicated to patients, which can be a barrier to follow-up care.

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Williams S.R.
        • Perera P.
        • Gharahbaghian L.
        The FAST and E-FAST in 2013: trauma ultrasonography: overview, practical techniques, controversies, and new frontiers.
        Crit Care Clin. 2014; 30: 119-150https://doi.org/10.1016/j.ccc.2013.08.005
        • Sgourakis G.
        • Lanitis S.
        • Korontzi M.
        • Kontovounisios C.
        • Zacharioudakis C.
        • Armoutidis V.
        • et al.
        Incidental findings in focused assessment with sonography for trauma in hemodynamically stable blunt trauma patients: speaking about cost to benefit.
        J Trauma. 2011; 71: E123-E127https://doi.org/10.1097/TA.0b013e3182249eaa
        • James M.
        • Francois M.
        • Yoeli G.
        • Doughlin G.
        • Lee S.
        Incidental findings in blunt trauma patients: prevalence, follow-up documentation, and risk factors.
        Emerg Radiol. 2017; 24: 347-353https://doi.org/10.1007/s10140-017-1479-5
        • Munk M.
        • Peitzman A.B.
        • Hostler D.P.
        • Wolfson A.B.
        Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center.
        J Emerg Med. 2010; 38: 346-350https://doi.org/10.1016/j.jemermed.2008.01.021
        • Lanitis S
        • Zacharioudakis C
        • Zafeiriadou P
        • Armoutides V
        • Karaliotas C
        • Sgourakis G
        Incidental findings in trauma patients during focused assessment with sonography for trauma.
        Am Surg. 2012; 78: 366-372
      1. Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Emergency Medicine. Patient Care and Procedural Skills, https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/110_EmergencyMedicine_2019.pdf?ver=2019-06-25-082649-063; 2019 [accessed 23 November 2019].

      2. Accreditation Council for Graduate Medical Education. Emergency Medicine Defined Key Index Procedure Minimums, https://www.acgme.org/Portals/0/PFAssets/ProgramResources/EM_Key_Index_Procedure_Minimums_103117.pdf?ver=2017-11-10-130003-693; 2017 [accessed 23 November 2019].

        • Weile J.
        • Laursen C.B.
        • Frederiksen C.A.
        • Graumann O.
        • Sloth E.
        • Kirkegaard H.
        Point-of-care ultrasound findings in unselected patients in an emergency department—results from a prospective observational trial.
        BMC Emerg Med. 2018 Dec 27; 18: 1-8https://doi.org/10.1186/s12873-018-0211-4
        • Warren K.S.
        • McFarlane J.
        The Bosniak classification of renal cystic masses.
        BJU Int. 2005; 95: 939-942https://doi.org/10.1111/j.1464-410X.2005.05442.x
        • Mavilia M.G.
        • Pakala T.
        • Molina M.
        • Wu G.Y.
        Differentiating cystic liver lesions: a review of imaging modalities, diagnosis and management.
        J Clin Transl Hepatol. 2018 Jun 28; 6: 208-216https://doi.org/10.14218/JCTH.2017.00069
        • Timmerman D.
        • Valentin L.
        • Bourne T.H.
        • Collins W.P.
        • Verrelst H.
        • Vergote I.
        Terms, definitions, and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group.
        Ultrasound Obstet Gynecol. 2000; 16: 500-505https://doi.org/10.1046/j.1469-0705.2000.00287.x
        • Levine D.
        • Brown D.L.
        • Andreotti R.F.
        • Benacerraf B.
        • Benson C.B.
        • Brewster W.R.
        • et al.
        Society of radiologists in ultrasound. Management of asymptomatic ovarian and other adnexal cysts imaged at US Society of Radiologists in Ultrasound consensus conference statement.
        Ultrasound Q. 2010; 26: 121-131https://doi.org/10.1097/RUQ.0b013e3181f09099
      3. American College of Obstetrics and Gynecology. Practice bulletin no. 174: evaluation and management of adnexal masses. Obstet Gynecol 2016;128(5):e210-26. https://doi.org/10.1097/AOG.0000000000001768.

        • Prakash Rajini T.
        • Kumar Bhardwaj A.
        • VJ
        • Kalyani Rao P.
        • Singh G.
        Urinary bladder diverticulum and its association with malignancy: an anatomical study on cadavers.
        Rom J Morphol Embryol. 2010; 51: 543-545
        • Zambon J.P.
        • Koslov D.S.
        • Mihai B.
        • Badlani G.H.
        Bladder and ureteral dysfunction leading to hydronephrosis and hydroureteronephrosis in adults.
        Urology. 2018; 117: 1-8https://doi.org/10.1016/j.urology.2017.11.049
        • Pandharipande P.V.
        • Herts B.R.
        • Gore R.M.
        • Mayo-Smith W.W.
        • Harvey H.B.
        • Megibow A.J.
        • et al.
        Rethinking normal: benefits and risks of not reporting harmless incidental findings.
        J Am Coll Radiol. 2016; 13: 764-767https://doi.org/10.1016/j.jacr.2016.03.017