title: Incidental findings in children with blunt head trauma evaluated with cranial CT scans.
abstract: OBJECTIVE
  Cranial computed tomography (CT) scans are frequently obtained in the evaluation of blunt head trauma in children. These scans may detect unexpected incidental findings. The objectives of this study were to determine the prevalence and significance of incidental findings on cranial CT scans in children evaluated for blunt head trauma.
  
  
  METHODS
  This was a secondary analysis of a multicenter study of pediatric blunt head trauma. Patients <18 years of age with blunt head trauma were eligible, with those undergoing cranial CT scan included in this substudy. Patients with coagulopathies, ventricular shunts, known previous brain surgery or abnormalities were excluded. We abstracted radiology reports for nontraumatic findings. We reviewed and categorized findings by their clinical urgency.
  
  
  RESULTS
  Of the 43,904 head-injured children enrolled in the parent study, 15,831 underwent CT scans, and these latter patients serve as the study cohort. On 670 of these scans, nontraumatic findings were identified, with 16 excluded due to previously known abnormalities or surgeries. The remaining 654 represent a 4% prevalence of incidental findings. Of these, 195 (30%), representing 1% of the overall sample, warranted immediate intervention or outpatient follow-up.
  
  
  CONCLUSIONS
  A small but important number of children evaluated with CT scans after blunt head trauma had incidental findings. Physicians who order cranial CTs must be prepared to interpret incidental findings, communicate with families, and ensure appropriate follow-up. There are ethical implications and potential health impacts of informing patients about incidental findings.
authors.affiliation: Department of Emergency Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan 48109, USA. alexroge@med.umich.edu
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Rogers
authors.forename: Cormac O
authors.initials: CO
authors.lastname: Maher
authors.forename: Jeff E
authors.initials: JE
authors.lastname: Schunk
authors.forename: Kimberly
authors.initials: K
authors.lastname: Quayle
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jacobs
authors.forename: Richard
authors.initials: R
authors.lastname: Lichenstein
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Powell
authors.forename: Michelle
authors.initials: M
authors.lastname: Miskin
authors.forename: Peter
authors.initials: P
authors.lastname: Dayan
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008297:Male; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014481:United States
keywords: brain imaging; computed tomography; congenital abnormalities/anomalies; emergency department