Report-Documented Frequency and Spectrum of Incidental Findings on Emergency Abdominopelvic Computed Tomography: A Retrospective Clinical Data Study from Saudi Arabia

Background/Objectives: Incidental findings (IFs) on emergency computed tomography (CT) are increasingly common as cross-sectional imaging utilization expands. Data from the Middle East are limited. We aimed to determine the report-documented frequency, anatomical distribution, and proportion of clinically actionable IFs on emergency abdominopelvic CT examinations at a tertiary-care center in southwestern Saudi Arabia. Methods: This retrospective cross-sectional study reviewed 705 consecutive emergency abdominopelvic CT examinations performed at King Fahd Central Hospital, Jazan, between 1 January 2023 and 31 December 2025. Two senior radiology residents (R3 and R4) extracted findings unrelated to the presenting indication from consultant-approved reports, applying a predefined terminology-standardization framework. Clinical actionability was defined a priori as a documented recommendation for further evaluation or follow-up. Descriptive statistics with 95% Wilson confidence intervals (CI) were calculated using R Software. Results: At least one IF was identified in 138 of 705 examinations, yielding a patient-level report-documented rate of 19.6% (95% CI 16.8% to 22.7%). A total of 255 IFs were recorded, averaging 1.85 findings per affected patient. The mean age was 42.3 ± 18.2 years; 78 patients (56.5%) were male and 116 (84.1%) were Saudi nationals. Findings were most often within the abdominopelvic cavity (159; 62.4%), followed by miscellaneous (64; 25.1%) and thoracic-vascular (32; 12.5%). At the secondary-category level, the most prevalent groups were spine (38; 14.9%), hepatobiliary (37; 14.5%), and genitourinary (31; 12.2%). Documented further work-up was recommended in 48 of 138 patients with IFs (34.8%; 95% CI 27.3% to 43.0%). Conclusions: Approximately one in five emergency abdominopelvic CT examinations contained incidental findings, with one-third requiring further evaluation. Spine, hepatobiliary, and genitourinary findings were most common. Variability in reported rates likely reflects differences in study methods and definitions. Future multicenter studies should evaluate standardized reporting approaches and follow-up strategies, together with their impact on reporting consistency, downstream investigations, and patient outcomes.