Department of Emergency Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan 48109, USA.
Pediatrics. 2013 Aug;132(2):e356-63. doi: 10.1542/peds.2013-0299. Epub 2013 Jul 22.
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.
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.
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.
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.
在儿童钝性头部创伤的评估中，经常进行头颅计算机断层扫描（CT）。这些扫描可能会发现意外的偶然发现。本研究的目的是确定在评估钝性头部创伤的儿童中，头颅 CT 扫描偶然发现的发生率和意义。
这是一项多中心儿科钝性头部创伤研究的二次分析。符合条件的患者为年龄<18 岁的钝性头部创伤患者，包括进行头颅 CT 扫描的患者。排除有凝血障碍、脑室分流器、已知既往脑部手术或异常的患者。我们从放射学报告中提取非创伤性发现。我们根据临床紧急程度对发现进行回顾和分类。
在母研究的 43904 名头部受伤的儿童中，有 15831 名接受了 CT 扫描，这些患者构成了研究队列。在其中 670 份扫描中发现了非创伤性发现，由于先前已知的异常或手术，有 16 份被排除在外。其余 654 份代表偶然发现的 4%发生率。其中 195 份（30%），占总样本的 1%，需要立即干预或门诊随访。
一小部分接受 CT 扫描评估的儿童在钝性头部创伤后有偶然发现。开具头颅 CT 扫描的医生必须准备好解释偶然发现，与家属沟通，并确保进行适当的随访。告知患者偶然发现的结果涉及到伦理问题和潜在的健康影响。
