ED-Ordered CTA and Significant Incidental Findings

August 28, 2015

Computed tomography angiography may show significant incidental findings that ED physicians should act upon.

Emergency room physicians need to be aware of the potential for clinically significant incidental findings and recommendations associated with CT angiography (CTA), according to a study published in The American Journal of Emergency Medicine.

Researchers from Harvard Medical School, in Boston, MA, performed a retrospective study to assess the outcomes, incidental findings, recommendations, and adherence to the recommendations on CTA studies that were performed at the request of ED physicians who were concerned about the potential for aortic dissection.

The researchers reviewed 370 dissection CTAs performed over 12 months. Patient mean age was 63 (15 to 97). The findings were:

PatientsResultNotes
46 (12.4%)Dissection19 (5.1%) were new dissections
329 (89%)At least one incidental finding 
106 (28.6%)Recommendations on the radiology report43% of recommendations were for pulmonary nodules

Thirty (28.3%) recommendations were acted upon, most commonly related to pulmonary nodule.

“CT angiography is useful in detecting aortic pathology,” the authors concluded. “However, ED physicians should be aware of the potential for clinically significant incidental findings and recommendations. Adherence to recommendations was limited and future research could investigate mechanisms to improve compliance.”