Incidental findings regularly generated by routine imaging scans

New study shows incidental findings on routine imaging scans for chest pain challenge efforts to reduce healthcare costs.

By Amy Wallace

May 8 (UPI) -- Researchers from Johns Hopkins have found incidental findings are generated more than half the time on routine scans used to diagnose heart attacks.

Incidental findings, a diagnosis of something other what is being tested for, is common in patients hospitalized with chest pain related to cardiac issues. Chest CT scans used to image the heart can show lung, thyroid nodules or enlarged lymph nodes, while chest X-rays can show bone lesions and arthritic changes.


Although doctors made incidental findings in more than half the analyzed records of 376 hospitalized patients who underwent routine imaging scans to help diagnose heart attacks over a two-year period, only 7 percent of the incidental findings were medically significant.

"Incidental findings present clinical and financial challenges," Dr. Venkat Gundareddy, director of the Collaborative Inpatient Medicine Service at Johns Hopkins Bayview Medical Center in Baltimore, said in a press release. "In our new study, we saw an association between the presence of incidental findings and longer length of stay in the hospital, in some cases because of further tests to explore those findings. Because this was an observational study, we can't conclusively attribute the added hospital days to one case, but we believe we have added to evidence that IFs [incidental findings] are a factor."


Researchers found incidental findings kept patients in the hospital an average of 26 percent longer than patients without incidental findings, and the higher sensitivity and accuracy of X-rays, MRIs, CT scans and ultrasounds led to more incidental findings such as kidney cysts, thyroid nodules, renal stones, enlarged lymph nodes, bone lesions, lung nodules and masses.

Incidental findings also added to healthcare costs due to the additional testing required to diagnose the incidental finding and necessary treatment.

"Choosing wisely what tests are needed for each patient, based on presenting complaints and pertinent history, would prevent unnecessary use of imaging and detection of incidental findings," Gundareddy said. "Establishing a robust outpatient care pathway to further workup incidental findings, as needed, would also decrease inpatient length of stay."

The study was published in the Journal of Hospital Medicine.

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