PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study

Incidental Findings on Computed Tomography in Children With Blunt Abdominal Trauma

STUDY OBJECTIVE

Nontraumatic, incidental findings on computed tomography (CT) may be discovered after blunt abdominal trauma in children; however, the rate and importance of these findings are not well known. The objective of this study was to determine the prevalence and types of incidental CT findings among injured children undergoing abdominal/pelvic CT.

METHODS

This was a planned secondary analysis of a multicenter prospective cohort study of children (<18 years) who underwent abdominal/pelvic CT after blunt trauma. We abstracted radiology reports for nontraumatic findings. We assessed and classified findings by their clinical urgency.

RESULTS

Of 7,581 children enrolled, 2,500 (33%) underwent abdominal/pelvic CT. The mean patient age was 10.1±4.8 years, and 1,446 (58%) were boys. A total of 988 (39.5%, 95% CI 37.6 to 41.5%) children had 1,552 incidental findings with a mean patient age of 10.6±4.8 years, of whom 59% were boys. Fifty-five (3.5%) incidental findings were considered to need immediate evaluation/treatment, and 84 (5.4%) were considered to require outpatient follow-up within 4 weeks. Most incidental findings, however, were considered less urgent regarding follow-up: 552 (36%) were routine, 574 (37%) were considered to have a potential need, and 287 (18%) did not need follow-up.

CONCLUSIONS

Forty percent of children undergoing CT scanning after abdominal trauma have incidental findings, few of which are clinically important and require timely follow-up. CT scans should be obtained only when necessary, and clinicians must be prepared to address incidental findings and ensure proper management.

Traumatic posterior fossa extradural hematoma in children: a meta-analysis and institutional experience of its clinical course, treatment and outcomes

Posterior fossa extradural hematoma (PFEDH) is rare but has a greater incidence amongst children. It is also associated with a rapid deterioration. The aim of this study was to present the management of PFEDH through our institutional experience and a meta-analysis. A retrospective single institution review of all children from 2004 to 2024 who underwent craniotomy for PFEDH was undertaken. The collected variables included: demographics, type of trauma, clinical findings, computed tomography findings, and clinical course. A systematic review using Ovid Medline, Ovid Embase, and Cochrane Central Register of Controlled Trials (CENTRAL), and meta-analysis were performed. Nineteen children with PFEDH who underwent surgery were identified. All 19 (100%) patients benefited from good Glasgow Outcome Scale (GOS) score 4-5, and there were no incidences of in-hospital mortality. From the systematic review, 391 patients, across twenty-four studies and our series, were included. A total of 308 were treated with surgery, whereas 83 patients were treated conservatively. A comparative meta-analysis was not performed as the two groups were deemed too heterogeneous in clinical characteristics. Instead, single-arm meta-analyses were performed. The pooled incidence of patients initially under conservative management requiring surgery was 9.90% (95%CI 1.61;22.21%, I2 = 35.2). The incidence of good functional outcomes in patients managed surgically and conservatively were 93.68% (95%CI: 88.69;97.57%, I2 = 0.0%), and 99.99% (95%CI: 96.53;100%, I2 = 0.0%), respectively. Overall pooled of mortality in patients managed surgically and conservatively were 0.57% (95%CI: 0.00;2.87%, I2 = 0.0%) and 0.00% (95%CI: 0.00;1.18%, I2 = 0.0%). Overall, our study reiterates that pediatric PFEDH is uncommon, and patients often present atypically. Based on our institutional experience and extrapolating data from our meta-analysis of the wider literature, neurosurgical intervention is a reliable therapeutic option with good clinical outcomes.