56 - Incidental Findings on Computed Tomography in Children with Blunt Abdominal Trauma

Poster Number: 56
Publication Number: 56.104

Irma Ugalde, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Kenneth Yen, University of Texas Southwestern Medical School, Dallas, TX, United States; Paul Ishimine, University of California, San Diego School of Medicine, San Diego, CA, United States; Nisa S. Atigapramoj, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Pradip P. Chaudhari, Children's Hospital Los Angeles, Los Angeles, CA, United States; Kevan A. McCarten-Gibbs, University of California, San Francisco, School of Medicine, Oakland, CA, United States; Mohamed Badawy, University of Texas Southwestern Medical School, Dallas, TX, United States; Nathan Kuppermann, University of California, Davis, School of Medicine, Sacramento, CA, United States; James F. Holmes, University of California, Davis, School of Medicine, sacramento, CA, United States

Background: Children who experience blunt abdominal trauma frequently undergo abdominal/pelvis CT during their evaluation. Non-traumatic incidental findings are found but the rate and importance of these findings are not well characterized. 

Objective: The objective of this study was to determine the prevalence and importance of incidental findings on abdominal CT in children with blunt abdominal trauma. 

Design/Methods: This was a planned secondary analysis of a multicenter prospective study of blunt abdominal trauma in children ( < 18 years) who underwent abdomen/pelvis CT. We abstracted CT reports for non-traumatic findings reported by the faculty radiologist and categorized them according to their clinical importance/follow-up need: immediate evaluation/treatment, timely outpatient follow-up, routine follow-up, or benign. Data are described with simple descriptive statistics and 95% confidence intervals (CI).

Results: Of 4,975 children enrolled, 1,494 (30%) underwent abdominal CT. The mean age was 9.1 ± 4.9 years and 2,847 (57%) were male. 733 (49%, 95% CI 46, 52%) patients had incidental findings. Incidental findings related to the trauma included: atelectasis (258), periportal edema (52), and shock bowel (8). The urgency of the remaining incidental findings was as follows: immediate evaluation/treatment needed (46, 4.3%, 95% CI 3.2, 5.7%), timely outpatient follow-up needed (60, 5.7%, 95% CI 4.3, 7.2%), routine outpatient follow-up needed (316, 29.8%, 95% CI 27.1, 32.7%) or benign (638, 60%, 95% CI 57, 63%). A 12-year-old was found to have appendicitis after a fall and underwent urgent surgery.Conclusion(s): Nearly half of children undergoing abdominal CT after trauma have incidental findings reported. Most of these findings are benign, however, a small number are clinically important and require timely follow-up. Providers must be prepared to recognize incidental findings, communicate with families, and ensure proper management. This further underscores that abdominal CT scans should be obtained only when necessary and clinicians must be prepared to address all findings.