Incidental findings on pediatric head CT: Rare, but problematic

In the largest, multicenter study of incidental findings on CT in pediatric blunt head trauma, about 4 percent of children had nontraumatic incidental findings, according to a study published July 22 in Pediatrics.

Nearly one third of these findings required urgent action or outpatient follow-up, reported Alexander J. Rogers, MD, of the University of Michigan, Ann Arbor, and colleagues.

“A small but important number of children evaluated with CT scans after blunt head trauma had incidental findings,” they wrote. “Physicians who order cranial CTs must be prepared to interpret incidental findings, communicate with families, and ensure appropriate follow-up.”

The study was a secondary analysis of a multicenter study of pediatric blunt head trauma that included patients younger than 18 years of age. A total of 15,831 of these patients underwent CT and they served as the cohort for the substudy.

Of those who received a CT scan, 4 percent had an incidental finding that was not a previously known abnormality, according to the results. Immediate intervention or timely outpatient follow-up was warranted in 30 percent of the incidental findings, representing about 1 percent of the overall CT-scanned cohort.

Rogers and colleagues noted that previous studies of incidental findings have resulted in highly variable results, and they attributed this partly to a lack of standardized definition for such findings. For example, the current study excluded findings consistent with sinusitis, a common finding that would have greatly raised the prevalence of incidental findings had it been included.

The authors also recognized the challenges of dealing with incidental findings, and how ethical and medicolegal perspectives on how to proceed could conflict with each other. A practitioner could fully disclose all findings, even those that are clinically insignificant, to protect himself from legal action, but this could unnecessarily lead to increased anxiety and costs to patients. The authors called for the development of strategies to handle these situations and pointed to the American College of Radiology’s position papers on “incidentalomas” as an example.

“Given the frequent use of advanced imaging for the evaluation of blunt head trauma in children, incidental findings will continue to be a challenging issue,” wrote Rogers and colleagues. “The decision about which incidental findings need to be disclosed to families will ultimately depend on the physician and, if known, families’ tolerance of risk and desire for 'full disclosure.'”