Prevalence and Clinical Relevance of Incidental Computed Tomography Findings in Pediatric Trauma: A Systematic Review and Meta-Analysis of 23,706 Patients.
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BACKGROUND: Radiological computed tomography (CT) reports often reveal incidental findings (IFs) unrelated to acute clinical concerns. These findings can range from clinically significant to benign variants, and their identification may have implications for follow-up care, resource utilization, and patient outcomes. OBJECTIVE: This study aims to estimate the pooled IFs on CT scans in pediatric trauma patients and to classify these findings into clinically meaningful categories. METHODS: PubMed, Web of Science, Scopus, and the Cochrane Library were searched from database inception up to April 2025 for studies reporting incidental findings on CT in pediatric trauma patients. Incidental findings were categorized as: category 1 (clinically significant requiring urgent follow-up), category 2 (indeterminate, requiring context-based evaluation), and category 3 (benign variants requiring no follow-up). Quantitative analyses were performed using Comprehensive Meta-Analysis (CMA) software, employing a random-effects model with 95% confidence intervals. RESULTS: Eleven studies were included in this meta-analysis. The overall pooled incidence of incidental findings on CT scans was 20.1% (95% CI: 9.6%-37.3%). Among incidental findings, 5.5% were classified as category 1, 36.7% as category 2, and 45.2% as category 3. Masses (tumors or nodules) were rare, constituting 0.8% (95% CI: 0.5%-1.3%), whereas cysts were more prevalent at 4.5% (95% CI: 2.8%-7.1%). Considerable heterogeneity was observed across studies (I² > 90% for most categories), likely reflecting differences in study design, populations, and reporting practices. CONCLUSION: Incidental findings are highly prevalent in pediatric trauma CT scans. This underscores the importance of standardized reporting and appropriate follow-up protocols. Categorization of these findings provides clinically useful insights, though the substantial heterogeneity observed suggests that clinical context plays an important role.