Incidental Findings Common in Pediatric Trauma CT Scans

TOPLINE:

Nearly 40% of children undergoing CT scans for blunt abdominal trauma have incidental findings, with 3.5% requiring immediate evaluation and 5.4% needing follow-up within 4 weeks.

METHODOLOGY:

• This secondary analysis of a multicenter prospective cohort study examined 2500 children (mean age, 10.1 years; 58% boys) who underwent abdominal/pelvic CT after blunt trauma across six pediatric emergency departments (EDs) in the United States.
• Researchers identified the CT scans with traumatic or nontraumatic abnormalities for detailed review.
• Findings were classified into five follow-up categories according to clinical urgency.

TAKEAWAY:

• About 39.5% of patients had a total of 1552 incidental findings.
• About 3.5% of patients with incidental findings required immediate care, 5.4% needed follow-up within 4 weeks, 36% were assigned to routine follow-up, 37% had a potential need for follow-up, and 18% required none.
• Researchers noted 72% of the findings in three organ systems: The gastrointestinal tract, bones, and kidneys.
• Of the 709 children with intraperitoneal fluid identified on CT, 19.2% had no identifiable intra-abdominal injuries.

IN PRACTICE:

“There are no predefined guidelines on the importance or what to do with such findings,” the authors wrote. They added, “ Radiologists should highlight incidental findings in the final impressions of their reports, and clinicians must be prepared to ensure their proper management.” 

SOURCE:

The study was led by Irma T. Ugalde, MD, MBE, University of Chicago Pritzker School of Medicine, Chicago. It was published online on January 23, 2025, in the Annals of Emergency Medicine.

LIMITATIONS:

The study’s limitations included a reliance on radiology reports rather than images, unstructured reporting, and a lack of inter-rater reliability assessment. Management decisions for incidental findings were not captured, limiting insight into current practices. Findings may not be generalizable due to differences in radiology personnel and reporting between general and pediatric EDs. Follow-up urgency categories were according to expert consensus, as no validated guidelines existed.

DISCLOSURES:

This work was supported by the National Institute of Child Health Human Development. No conflicts of interest were reported in the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.