Focal Cystic Pancreatic Lesion Follow-up Recommendations After Publication of ACR White Paper on Managing Incidental Findings.

PURPOSE: To describe the variation in radiologists' follow-up recommendations for focal cystic pancreatic lesions (FCPL) after publication of the 2010 ACR incidental findings White Paper and determine adherence to guidance of the ACR Incidental Findings Committee. METHODS: Institutional Review Board approval was obtained for this retrospective, HIPAA-compliant observational study. Patients with FCPL were identified from abdominal CT and MRI reports generated in 2013 using natural language processing software. Patient-, lesion-, and radiologist-specific variables were recorded. Primary outcome was whether a follow-up recommendation was made, and if it included a specific study or intervention and recommended time for follow-up. χ2 and logistic regression models were used to identify predictors and controlled for recommendation. These data were compared with 2009 data obtained before the White Paper's publication. Secondary outcome was adherence to the ACR's guidance. RESULTS: During calendar year 2013, 1,377 reports describing FCPLs were identified in 1,038 patients. After excluding examinations from low-volume readers (n = 80), radiologists recommended follow-up imaging in 13.5% (175/1,297) of cases, a decrease from 2009 when it was recommended in 23.7% (221/933) of cases (P < .001). Findings were consistent across radiologists after controlling for patient- and lesion-specific variables. Variability in follow-up recommendations persists between radiologists (2.4-fold difference in 2013 versus 2.8-fold difference in 2009). Radiologists adhered to ACR guidance principles 47.4% of the time. CONCLUSIONS: Despite published guidance recommendations and reported awareness of them, fewer than half of follow-up recommendations for FCPL are consistent with the guidance and considerable variability persists among radiologists.

Standard computed tomography of the chest, abdomen, and pelvis is sensitive and cost-effective for the detection of fractures of the shoulder girdle.

Computed tomography of the chest, abdomen, and pelvis (CTCAP) has become the mainstay of diagnosis in stable blunt trauma patients. The purpose of this study was to investigate whether standard CTCAP has adequate sensitivity to identify fractures of the scapula, clavicle, and humeral head to replace routine radiographs of the shoulder. A retrospective chart review was carried out from January 1, 2004, to December 31, 2007, at Morristown Memorial Hospital. Inclusion criteria were all shoulder fracture patients in our trauma registry who underwent both a CTCAP and plain radiographs of the injured shoulder. Data were collected for patient age, sex, Injury Severity Score, mechanism of injury, and fracture location. Sensitivity was calculated for each diagnostic modality as well as hospital costs and radiation dose of plain radiographs. A total of 374 charts were reviewed and 98 patients were included in the study with a total of 117 fractures. The sensitivity of trauma CTCAP for scapula fractures was 100 per cent, clavicle fractures 98 per cent, and humeral head fractures 100 per cent. The sensitivity of the shoulder series for scapula fractures was 60 per cent, clavicle fractures 85 per cent, and humeral head fractures 100 per cent. The plain radiographs added $298 in hospital charges and 0.191 mSv of radiation per patient. CTCAP is a sensitive tool for identifying fractures in the shoulder girdle. Therefore, CTCAP can replace the routine radiographs of the shoulder resulting in less total radiation exposure of the trauma patients. This also would lead to lower healthcare cost and better diagnostic workflow.

Does patient age and height of fall alone require trauma team activation?

Our American College of Surgeons Level I trauma center uses physiological data and injury patterns to identify fall patients at risk. We hypothesized that height of fall and patient age impacted injury severity and analyzed if they were significant predictors of the need for trauma team activation. Charts were reviewed from July 1, 2004, to June 30, 2007, for age; sex; Injury Severity Score (ISS); height of fall and admission to the intensive care unit, operating room, stepdown unit, floor; or death. Exclusion criteria were physiological, neurologic, or airway compromise and penetrating neck or torso injuries. ISS was used as a positive control. A total of 1865 fall patients were treated during the period of data collection, and 1348 patients were eliminated by exclusion criteria, leaving 517 patients for study. Although patient age did not correlate with the need for trauma team activation, there was a statistically significant association between age and admission to the hospital from the emergency room (P < 0.05; area under curve [AUC] = 0.713; 95% confidence interval [CI], 0.656 to 0.770). Similarly, although the height of fall alone did not have a significant predictive value for the need of trauma team activation, there was a clear association of the height of fall with hospital admission (AUC = 0.589; 95% CI, 0.519 to 0.658). Patient age and height of fall alone are not criteria for trauma team activation in the absence of physiological, neurologic, or airway compromise.