Date of Award

January 2013

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Christopher Moore

Subject Area(s)

Medical imaging and radiology

Abstract

PREVALENCE AND CATEGORIZATION OF INCIDENTAL FINDINGS ON COMPUTED TOMOGRAPHY FOR POSSIBLE RENAL COLIC.

Sarah E Goss (Sponsored by Christopher Moore). Department of Emergency Medicine, Yale University, School of Medicine, New Haven, CT.

This study aimed to determine the prevalence and clinical importance of incidental findings established on computed tomography "flank pain protocols" (CT FPP) obtained for suspected renal colic, based upon accepted radiographic guidelines. We hypothesized that the prevalence of clinically important incidental findings would be greater than 10%, would increase with age, and would occur more frequently in females.

5,383 CT FPPs performed on adult patients at two emergency departments over a 5.5 year period were retrospectively reviewed. All scans initially classified with important incidental findings as well as random subsets of 60, 50, and 50 subjects underwent blinded re-review by the author. An additional random subset of 100 scans was blindly re-reviewed by an investigating physician and inter-rater variability with the author was calculated.

875 clinically important incidental findings were identified in 681 (12.65%, 95% CI: 11.79%-13.56%) scans. Individuals > 80 years old had a prevalence four times greater than those aged 18-30: 28.9% (95% CI: 22.4%-36.4%) vs. 6.9% (95% CI: 5.5%-8.6%). Females had a higher prevalence of important incidental findings compared to males: 13.4% (95% CI: 12.2%-14.7%) vs. 11.9% (95% CI: 10.7%-13.2%) The kappa value for inter-rater variability between the author and physician investigator was 0.69 (95% CI: 0.49- 0.90).

We concluded that clinically important incidental findings occur in approximately 12.65% of CT FPPs in the emergency department and occur more frequently in females and older individuals. Prospective studies which use radiographic guidelines to characterize incidental findings as well as examine the outcome and cost of their work-up are encouraged.

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