218 Incidental Findings on Pediatric Abdominal Computed Tomography at a Pediatric Trauma Center

Abstract

The use of computed tomography (CT) in pediatric abdominal trauma has increased due to the availability of CT scans. This has led to increased detection of incidental findings which can be benign, while others may require follow up or urgent evaluation. This study describes the frequency and type of incidental findings on abdominal CT of trauma patients at a pediatric trauma center. This was a retrospective, observational study of pediatric patients ≤ 21 years of age presenting to the emergency department (ED) between January 1, 2004 and July 31, 2016. The study was conducted at Staten Island University Hospital, a 700-bed, tertiary-care teaching hospital in Staten Island, NY. The pediatric ED is a level II trauma center with a census of 25,000 patient visits per year. Information was extracted from a computer database. Prior to review, a consensus panel consisting of board certified emergency, pediatric and radiology physicians determined the appropriate classification of incidental findings. Each record was reviewed by a physician trained in the study protocol and data abstraction and was then reviewed by a second board certified physician to ensure consistency and accuracy. All findings were categorized into three groups; (1) Benign anatomic variants which require no form of intervention, (2a) Benign pathologic findings not requiring further investigation based on the known natural histories of these lesions, (2b) Likely benign pathologic, may require outpatient monitoring and (3) Pathologic findings requiring further workup. Group 3 was subcategorized as follows as (3a) Requiring attention before discharge and (3b) requiring follow-up as outpatient. 1073 trauma patients underwent a CT of the abdomen and pelvis during the study period. The mean age 15.5 years and 707 (66%) were male. 418 incidental findings were identified in 345 subjects. Of these, 290 (69%) were benign, 60 (14%) were likely benign pathologic, requiring possible outpatient monitoring. The most common findings in this category were adnexal and renal cysts. 68 (16%) of incidental findings required some form of further evaluation. The most common pathological findings were hepatic steatosis and hydronephrosis. Inter-rater agreement for classification of incidental findings was 0.96 (95% CI 0.93-0.98). Of those requiring further evaluation, 5 findings (1%) wanted further evaluation prior to discharge (Table 1). Nearly one third of patients had at least one radiographic finding not related to their traumatic injury. Of these, more than two-thirds had injuries not requiring further evaluation, but a significant number of patients required some form of further evaluation. Although the clinical significance of these findings is unclear, systems need to be in place for informing patients of these findings.