Prevalence and Clinical Significance of Incidental Findings in Cranial Computed Tomography in Patients with Head Trauma

Objective: This study evaluated the prevalence and clinical significance of incidental findings detected on cranial computed tomography in patients admitted to the emergency department (ED) with head trauma.
Material and Methods: This single-center, retrospective study included 12.605 consecutive patients who presented to the ED due to head trauma from January 2017 to December 2019. Patients were divided into those with and without incidental findings. Patients with incidental findings were further categorized according to clinical significance. Demographic and clinical characteristics were compared among the patient groups.
Results: The study included 12.605 patients, including 8.771 males (66.2%) and 3.834 females (33.8%), with a mean age of 34.3±22.6 years. Incidental findings were not detected in 86.2% (n=10.864) of the patient population. The frequency of incidental and clinically significant findings increased with advanced age (p<0.001 for both). In addition, incidental findings were more common in males (p<0.001). Moreover, a statistically significant increase in the frequency of brain atrophy, infarction, ischemia, and intracerebral space-occupying lesions (such as mass, lipoma, and meningioma) was observed, especially in patients of advanced age. Conversely, the frequency of arachnoid cysts, hydrocephalus, megacisterna magna, and sinusitis was more common in the younger age group (p<0.05 for all).
Conclusion: Overall, 86.2% of patients with head trauma had no incidental findings. Additionally, most incidental findings were benign and non-critical. The frequency of incidental and clinically significant findings increased with advanced age. Furthermore, incidental findings were more common in males.

Keywords: Clinical significance, cranial computed tomography, head trauma, incidental findings