Incidental Findings on Abdominal CT in Pediatric Blunt Trauma: A Prevalence Study

Approximately 40% of children who undergo CT scans following blunt abdominal trauma have incidental findings, with ~4% requiring immediate evaluation and management and 5.4% needing follow-up within 4 weeks, according to a recent study published in Annals of Emergency Medicine.1 

Irma T Ugalde, from the Department of Pediatrics, Section of Emergency Medicine, University of Chicago Pritzker School of Medicine, Chicago and colleagues conducted this secondary analysis of a multicenter prospective cohort study to determine the prevalence and types of incidental findings on abdominal/pelvic CT scans in children (<18 years) with blunt trauma. The participants underwent CT imaging following blunt trauma across six pediatric emergency departments (EDs) in the United States. Radiology reports were reviewed to identify nontraumatic findings, which were then assessed and categorized into five based on their clinical urgency: Urgent (requiring immediate treatment), requiring outpatient follow-up within 4 weeks, routine follow-up needed, potential need for follow-up and no follow-up needed. 

Among the 7581 children enrolled in the study, 2,500 (33%) underwent abdominal/pelvic CT. The average patient age was 10.1 years, with the majority (58%) being boys.

 A total of 1,552 incidental findings were detected in 988 children (39.5%). The average age of children with incidental findings was 10.6 years; 59% were boys. Among the incidental findings, 55 (3.5%) were urgent, while 84 (5.4%) needed outpatient follow-up within 4 weeks. However, the majority of the incidental findings were less urgent: 552 (36%) were classified as routine, 574 (37%) had a potential need for follow-up, and 287 (18%) required no further evaluation. Notably, 72% of the findings involved three organ systems: the gastrointestinal tract, bones, and kidneys. Among 709 children with intraperitoneal fluid identified on CT scan, 19.2% had no identifiable intra-abdominal injuries. 

This study shows that while incidental findings were common, most did not require immediate evaluation. It further highlights the need for judicious use of CT scans, and the fact that clinicians must be prepared to interpret the incidental findings and address them without causing undue alarm. There is also a need for clear guidelines regarding management of incidental findings.

Reference

1.   Irma T Ugalde, et al. Incidental findings on computed tomography in children with blunt abdominal trauma. Ann Emerg Med. 2025 Jan 22:S0196-0644(24)01271-X. doi: 10.1016/j.annemergmed.2024.12.012.