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Incidental Findings on Computed Tomography in Children With Blunt Abdominal Trauma
Irma T Ugalde1, Kenneth Yen2, Grant Tatro3
1Department of Pediatrics, Section of Emergency Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL.
Insights
Computed tomography (CT) scans in children after blunt abdominal trauma reveal incidental findings in 40% of cases. Few of these nontraumatic findings require urgent follow-up, emphasizing judicious CT use.
Area of Science:
- Pediatric Radiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Nontraumatic incidental findings on computed tomography (CT) are common after pediatric blunt abdominal trauma.
- The clinical significance and management of these incidental findings are not well-established.
Purpose of the Study:
- To determine the prevalence and types of incidental CT findings in children following blunt abdominal trauma.
- To assess the clinical urgency and follow-up recommendations for these incidental findings.
Main Methods:
- Secondary analysis of a multicenter prospective cohort study involving children (<18 years) with blunt abdominal trauma.
- Radiology reports of abdominal/pelvic CT scans were reviewed for nontraumatic findings.
- Incidental findings were classified based on clinical urgency and need for follow-up.
Main Results:
- Of 2,500 children who underwent CT, 988 (39.5%) had 1,552 incidental findings.
- Only 3.5% of incidental findings required immediate evaluation/treatment, and 5.4% needed outpatient follow-up within 4 weeks.
- The majority of findings were routine (36%), had potential need (37%), or required no follow-up (18%).
Conclusions:
- Approximately 40% of pediatric patients with blunt abdominal trauma have incidental CT findings.
- Most incidental findings are not clinically significant and do not require urgent management.
- Judicious use of CT scans and preparedness for managing incidental findings are crucial in pediatric trauma care.
Study Objective:
Nontraumatic, incidental findings on computed tomography (CT) may be discovered after blunt abdominal trauma in children; however, the rate and importance of these findings are not well known. The objective of this study was to determine the prevalence and types of incidental CT findings among injured children undergoing abdominal/pelvic CT.
Methods:
This was a planned secondary analysis of a multicenter prospective cohort study of children (<18 years) who underwent abdominal/pelvic CT after blunt trauma. We abstracted radiology reports for nontraumatic findings. We assessed and classified findings by their clinical urgency.
Results:
Of 7,581 children enrolled, 2,500 (33%) underwent abdominal/pelvic CT. The mean patient age was 10.1±4.8 years, and 1,446 (58%) were boys. A total of 988 (39.5%, 95% CI 37.6 to 41.5%) children had 1,552 incidental findings with a mean patient age of 10.6±4.8 years, of whom 59% were boys. Fifty-five (3.5%) incidental findings were considered to need immediate evaluation/treatment, and 84 (5.4%) were considered to require outpatient follow-up within 4 weeks. Most incidental findings, however, were considered less urgent regarding follow-up: 552 (36%) were routine, 574 (37%) were considered to have a potential need, and 287 (18%) did not need follow-up.
Conclusions:
Forty percent of children undergoing CT scanning after abdominal trauma have incidental findings, few of which are clinically important and require timely follow-up. CT scans should be obtained only when necessary, and clinicians must be prepared to address incidental findings and ensure proper management.
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