Republication: Incidental Findings On Intensivist Bedside Ultrasonographic Examinations: Why Should We Care?

Introduction: The primary goal of intensivist bedside ultrasonography (INBU) is the assessment of patient hemodynamic and volume status. Inevitably, INBU examinations provide views of various thoracic and abdominal structures. Despite the rapid recent increase in utilization of INBU, there are no published descriptions of incidental findings and/or their significance in this setting.Methods: Echocardiographic and vena cava examinations were performed by noncardiologist intensivists in 124 Surgical Intensive Care Unit (SICU) patients using hand-carried ultrasound. In addition, any findings that were deemed "incidental" were recorded. Information analyzed included patient demographics, time to complete INBU examination, and the nature of each incidental finding. Incidental findings were grouped into cardiac, pulmonary, and abdominal. To determine whether incidental INBU findings may have influenced subsequent diagnostic testing patterns, radiographic, and echocardiographic examinations directly relevant to the INBU findings and performed within 48 h of the INBU examination were reviewed.Results: Fifty-eight out of 124 (46.8%) patients in the study group had at least one incidental finding. There were 86 incidental findings, with 23 patients having more than one incidental finding. Forty-eight of 86 incidental findings (55.8%) were cardiac-related, 30 (34.9%) were pulmonary-related, and 8 (9.30%) were abdominal. There were significantly more diagnostic tests performed within 48 h of INBU in the incidental finding group (1.56/patient) than in the nonincidental group (1.18/patient, P< 0.04). The most common post-INBU diagnostic tests were chest radiogram (62%), formal trans-thoracic echocardiography (21%), and abdominal roentgenogram (14%). Computed tomography, formal abdominal ultrasonography, and trans-esophageal echocardiograms were performed less often. Four of 58 patients (6.9%) had a significant change in clinical management associated with the incidental INBU findings. One patient underwent percutaneous drainage of a pleural effusion; three underwent formal echocardiography, with subsequent change in medical management.Conclusions: Nearly half of all SICU patients who underwent INBU were found to have at least one incidental finding. The presence of an incidental finding may have influenced the subsequent pattern of clinical diagnostic testing. In addition, incidental findings on INBU were associated with a significant change in clinical management in nearly 7% of patients.The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice based learning and improvement, Systems based practice.Republished with permission from: Stawicki SP, Shiroff AM, Hayden GE, Panebianco NL, Kirkpatrick JN, Horan AD, Gracias VH, Dean AJ. OPUS 12 Scientist 2008;2(3):11-14.