Incidental Findings on Pediatric Abdominal Computed Tomography At A Pediatric Trauma Center

Daoud, Youanna; Philip, Alexander; Altberg, Gal; Leader, Hadassa; Neuman, Jeremy; Hahn, Barry

doi:10.1016/j.jemermed.2017.08.003

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…The study analyzed 418 incidental findings from 345 patients and found that 60 might require outpatient monitoring. The study also concluded that approximately one-third of the patients had radiological findings not attributed to their injuries, and one-third of the patients needed further workup [12].…”

Section: Discussionmentioning

confidence: 96%

Assessment of the Response to Abdominal and Pelvic Computed Tomography Report Recommendations: A Single-Center, Retrospective, Chart Review Study

AlSharif¹,

Alasaad²,

Bukhari³

et al. 2022

Cureus

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The radiology report is the primary form of communication between the radiologists and referring clinicians. It is a structured document containing several key components pertaining to the interpretation of radiological examinations and may require the addition of follow-up imaging recommendations to optimize patient outcomes. This study aims to determine whether follow-up imaging recommendations are being acknowledged and acted upon by referrers. MethodsThis retrospective study was conducted at a single tertiary hospital. Prerecorded BESTCare data of patients who underwent abdominal and pelvic computed tomography (CT) scans between October 1, 2017, and December 31, 2017, and received recommendations for further evaluation were collected after obtaining ethical approval from the local authority. Data of patients younger than 14 years old, patients who did not receive a recommendation, and patients who had CT scans that were uploaded to the BESTCare system but were performed outside the institution were excluded. The collected data were recorded in a passwordprotected Microsoft Excel file for further analysis. ResultsA total of 523 report recommendations from 422 abdominal and pelvic CT reports were analyzed. The most common organs indicated for CT scan evaluation were the breast (N = 54, 10.33%), kidney (N = 46, 8.80%), lymph node (N = 36, 6.88%), and colon (N = 33, 6.31%). The most common type of further evaluation recommended was further imaging (N = 410, 78.39%). A total of 278 (53.15%) recommendations were not performed, with 199 (71.58%) not having a documented rationale for noncompliance. ConclusionThe majority of the follow-up imaging recommendations to ordering physicians were not carried out. This study highlights the need for notification and audit systems to monitor compliance with follow-up recommendations. Improving the communication between radiologists and referring physicians is key to optimizing patient healthcare.

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Section: Discussionmentioning

confidence: 96%

Assessment of the Response to Abdominal and Pelvic Computed Tomography Report Recommendations: A Single-Center, Retrospective, Chart Review Study

AlSharif¹,

Alasaad²,

Bukhari³

et al. 2022

Cureus

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“…Prior studies have placed the rates of incidental findings at 4% for head CT and up to 50% for abdominal CT in children. [26][27][28] These findings can lead to increases in hospital stay, diagnostic tests and stress to families.…”

Section: Discussionmentioning

confidence: 99%

“…Although little has been published regarding the impact of false positive findings on CT scans for trauma in children, the significant rate of incidental findings is well established. Prior studies have placed the rates of incidental findings at 4% for head CT and up to 50% for abdominal CT in children 26–28 . These findings can lead to increases in hospital stay, diagnostic tests and stress to families.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography Scan Utilization in Pediatric Trauma

et al. 2020

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Introduction: Computerized tomography (CT) scans are the mainstay of diagnostic imaging in blunt trauma. Particularly in pediatric trauma, utilization of CT scans has increased exponentially in recent years. Concerns regarding radiation exposure to this vulnerable population have resulted in increased scrutiny of practice. What is not known is if liberal imaging practices decrease length of stay by eliminating the need for clinical observation, and the impact of false-positive rates from liberal use of CT scanning on clinical outcomes.Methods: Medical records from a nonaccredited pediatric trauma center with a practice of liberal imaging were reviewed over a 2-year period. Total CT scans obtained were recorded, in addition to length of stay, age, and Injury Severity Score (ISS). Rates of clinically significant imaging findings were recorded, as were false positive findings and complications of imaging.Results: Out of 735 children, 58% underwent CT scanning, and if scanned, received an average of 2.4 studies. Clinically significant findings were documented in 20% of head CTs, 2% of cervical spine CTs, 3.5% of chest CTs, 24% of facial CTs, and 14.7% of abdominal CTs. False-positive findings were found in 1.5% of head CTs, 1.2% of cervical spine CTs, 2.4% of chest CTs, and 2.5% of abdominal CTs. Liberal CT scanning was not associated with decreased length of stay. In contrast, obtaining CT scans on more than 4 body regions was independently predictive of longer length of stay, independent of ISS.Conclusions: False-positive rates of CT scans for trauma were low in this cohort. However, when scanning the cervical spine or the chest, for every 2 clinically significant findings obtained, there was at least one false positive result, calling into question the practice of liberal imaging of these regions. Liberal utilization of CT scan did not allow for more rapid discharge home, and for more than 4 CTs was independently associated with longer hospital stay.

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“…Incidental findings are not uncommon on CT done for trauma, but malignancies are rarely found under these circumstances in children. 13,14 While the IVC abnormality was noted on the initial CT, it was treated as a potential thrombus consequent to the accident. Only the lesion's continued presence and increase in size on subsequent imaging led the caregivers to seek alternate diagnoses and refer the patient for further investigation.…”

Section: Incidental Diagnosis Of An Epithelioid Hemangioendothelioma ...mentioning

confidence: 99%

Incidental diagnosis of an epithelioid hemangioendothelioma of the inferior vena cava in a teenager after a motor vehicle accident

Lemoine

Lust

Sokol

et al. 2021

Pediatric Blood & Cancer

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Incidental Findings on Pediatric Abdominal Computed Tomography At A Pediatric Trauma Center

Cited by 6 publications

References 18 publications

Assessment of the Response to Abdominal and Pelvic Computed Tomography Report Recommendations: A Single-Center, Retrospective, Chart Review Study

Assessment of the Response to Abdominal and Pelvic Computed Tomography Report Recommendations: A Single-Center, Retrospective, Chart Review Study

Computed Tomography Scan Utilization in Pediatric Trauma

Incidental diagnosis of an epithelioid hemangioendothelioma of the inferior vena cava in a teenager after a motor vehicle accident

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