Incidental findings from pediatric CT scans rare but significant

Incidental findings are a rare but significant result of pediatric CT scans of children with head injuries, according to a study published in the August issue of Pediatrics.

The study involved about 44,000 children who presented for head injury at 25 hospital emergency departments. Nearly 16,000 had CT scans to evaluate their injuries, and about 4 percent of those scans revealed incidental findings ranging from enlarged tonsils to life-threatening cancers.

The researchers, led by Alexander Rogers, an assistant professor of pediatric emergency medicine at the University of Michigan Health System, stratified the incidental findings into three categories: those needing immediate evaluation or treatment; those needing appropriate timely outpatient follow up; and those that required further investigation if the problems were causing symptoms. Thirty percent of incidental findings--or 1 percent of the patients scanned--needed immediate evaluation or follow up.

Considering the relatively small percentage of patients with urgent incidental findings, the authors recommended that no changes are needed in current CT scan guidelines and that emergency physicians should continue to scan children with CT when it is medically justified.

The authors also noted there are challenges related to dealing with how to proceed with incidental findings. For example, should a practitioner protect him or herself from legal action and relate all incidental findings--even those considered to be insignificant--despite the fact that it may lead to increased costs and anxiety to patients?

"Because the practice of medicine has embraced technologies that provide information beyond the actual clinical question, a need to develop strategies to handle unexpected information now exists," Rogers said, according to an announcement. "Particularly in the emergency room, doctors must decide quickly whether and how to disclose information to a family with whom they have no prior relationship and do not know what their response is likely to be."

To learn more:
- see the study in Pediatrics
- read the announcement