How are incidental findings identified and managed in urgent and emergency care? A rapid scoping review.

Introduction: Incidental findings are unexpected abnormal findings during routine care. Urgent and emergency care (UEC) professionals in emergency departments, ambulance services and urgent treatment centres are presented with opportunities for early intervention and could use incidental findings to reduce long-term disease burden. However, limited evidence exists regarding the identification and management of incidental findings, particularly in pre-hospital settings. This scoping review aimed to investigate existing primary research on incidental findings across UEC settings.

Methods: Two databases were searched (MEDLINE Complete and CINAHL Complete) in June 2024. Two researchers screened results, performed reference and citation searching and reviewed full texts. Included studies underwent data extraction and critical appraisal before being synthesised narratively.

Results: Initial searches yielded 245 records; 10 were included for full-text screening. An additional 418 articles were identified through reference and citation searching, of which 38 were included for full-text screening. Eighteen articles were included after screening, with an additional two added from another source. Articles explored incidental findings such as elevated blood pressure, atrial fibrillation, late-returning laboratory results and abnormal findings on sonography. Reported prevalence varied, with only 17.4% of patients with elevated blood pressure referred for follow-up, though 40.6% were later diagnosed with hypertension. New-onset atrial fibrillation was found in 2.7% of patients not transported by ambulance service. Between 47% and 68% of patients with abnormal sonographic findings were referred for further care.Incidental findings are moderately prevalent across UEC settings, but referrals for follow-up are inconsistent. Factors influencing referrals include patient demographics, ownership of findings, time constraints and clinician education.

Conclusion: Further research is required to understand socio-demographic characteristics and how they influence the decision to act on incidental findings. Streamlined low-effort referral mechanisms and clear delineation of responsibility may improve outcomes. Further research is needed, particularly in ambulance service practice, where findings differ from other settings and remain underexplored.