Incidental Findings on Computed Tomography in Children With Blunt Abdominal Trauma - 23/01/25

Doi : 10.1016/j.annemergmed.2024.12.012

Irma T. Ugalde, MD, MBE ^a,^⁎ , Kenneth Yen, MD ^b, Grant Tatro, MD ^c, Paul Ishimine, MD ^d, Nisa S. Atigapramoj, MD ^e, Pradip P. Chaudhari, MD ^f, Kevan A. McCarten-Gibbs, MD ^g, Mohamed Badawy, MD ^b, Jeffrey S. Upperman, MD ^h, Nathan Kuppermann, MD, MPH ^i,^j, James F. Holmes, MD, MPH ⁱ
^a Department of Pediatrics, Section of Emergency Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL
^b Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Health and University of Texas Southwestern, Dallas, TX
^c Virginia Commonwealth School of Medicine, Richmond, VA
^d Departments of Emergency Medicine and Pediatrics, University of California, San Diego, School of Medicine, La Jolla, CA
^e Department of Emergency Medicine, UCSF Benioff Children's Hospital, Oakland, CA
^f Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA
^g Department of Emergency Medicine, UCSF Benioff Children's Hospital, Oakland, CA
^h Department of Pediatric Surgery, Vanderbilt University, Nashville, TN
ⁱ Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA
^j Department of Pediatrics, UC Davis School of Medicine, Sacramento, CA

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 23 January 2025

Abstract

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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Keywords : Advanced imaging, Incidental findings, Pediatric trauma

Plan

Introduction

Background

Materials and Methods

Study Design and Setting

Study Population

Measurements and Outcomes

	Supervising editor: Lois K. Lee, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: NK and JFH conceived the study, designed the trial, obtained research funding, and recruited participating centers. NK, JFH, ITU, KY, PI, NSA, PPC, KAM, MH, GT, and JSU supervised the conduct of the trial and data collection. NK and JFH managed the data, including quality control. NK and JFH provided statistical advice on study design and analyzed the data. ITU analyzed the data and drafted the initial manuscript; all authors contributed substantially to its revision. ITU takes responsibility for the paper as a whole.
	Data sharing statement: The data for this study will be made available for qualified researchers with the execution of a Data Sharing Agreement.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This work was supported by a grant from the National Institute of Child Health Human Development R01 HD084674.
	Presentation information: Oral abstract Society of Emergency Medicine, New Orleans, LA; May 13, 2022.
	Please see page XX for the Editor’s Capsule Summary of this article.