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Pediatric cervical spine injuries on CT: difference in accuracy of interpretations by pediatric versus non-pediatric
Nabil Hassan1, Chloe Butler2, James DeCou3
1Division of Pediatric Critical Care, OSF Healthcare Children's Hospital of Illinois, 530 NE Glen Oak Ave, Peoria, IL, 61637, USA.
Insights
A pediatric radiologist (PR) demonstrated improved accuracy in identifying pediatric cervical spine injuries on CT scans compared to a non-pediatric radiologist (NPR). This enhanced interpretation by the PR led to better detection of injuries, particularly at the craniocervical junction.
Area of Science:
- Radiology
- Pediatric Imaging
- Spinal Imaging
Background:
- Cervical spine injuries in children require accurate and timely diagnosis.
- Computerized tomography (CT) is a common imaging modality for evaluating pediatric cervical spine trauma.
- Interpretation of CT scans by non-specialists may lead to missed diagnoses.
Purpose of the Study:
- To compare the diagnostic accuracy of initial cervical computerized tomography (CCT) interpretations between non-pediatric radiologists (NPRs) and pediatric radiologists (PRs).
- To evaluate the impact of specialized radiologist experience on the detection of pediatric cervical spine injuries.
Main Methods:
- Retrospective review of pediatric trauma patients (2010-2014) with CCT and MRI of the cervical spine.
- Inclusion of patients with negative CCT but positive MRI (study group) and matched controls with negative CCT and MRI.
- Reinterpretation of CCT scans by an experienced PR, blinded to clinical and imaging data, and comparison with initial NPR interpretations and MRI findings.
Main Results:
- The PR correctly identified 6 of 21 CCTs initially read as negative by NPRs, revealing injuries (mainly craniocervical junction) confirmed by MRI (28.6% improvement, P < .001).
- NPR interpretation showed a sensitivity of 71.2% and specificity of 91.7%.
- PR reinterpretation achieved 100% sensitivity and 100% positive predictive value for the study group, with improved negative predictive value for controls.
Conclusions:
- Pediatric radiologists demonstrate superior accuracy in interpreting pediatric cervical spine CT scans compared to non-pediatric radiologists.
- Specialized interpretation by PRs can significantly improve the detection rate of subtle pediatric cervical spine injuries.
- This highlights the importance of subspecialty expertise in pediatric radiology for optimizing trauma care.
Purpose:
To retrospectively compare the accuracy of interpretation of initial cervical computerized tomography (CCT) by a non-pediatric radiologist (NPR) versus a pediatric radiologist (PR).
Methods:
IRB approval and consent waiver were granted to review all injured children from 2010 to 2014 in the trauma registry with CT and magnetic resonance imaging (MRI) of the cervical spine. Patients with negative CCT who subsequently had positive MRI from a single institution comprised the study group. Patients with negative CCT and MRI, matched by age, gender, and severity scores, comprised the control group. The CCTs from both groups were initially interpreted at the time of service by a NPR. Subsequently, a single PR with 20 years of experience blinded to clinical/imaging data reinterpreted these CCT examinations. CT interpretations were then compared with MRI results and evaluated for statistical significance using SSPS software. The data analysis utilized summary statistics, two-tailed binomial test, and univariate χ2 test. Significance for all comparisons was assessed at P < 0.05.
Results:
The study group was comprised of the 21 patients with negative CCT and positive MRI. Of the cohort included, 76% (16) were male and 24% (5) were female. The age range was 1 month-17 years, with a mean age of 9.7 years. CCT interpretation by NPR had a specificity of 91.7% (sensitivity 71.2%, positive predictive value 81.3%, and negative predictive value 86.3%) compared with results of MRI. Six of the 21 negative CCTs were interpreted by the PR as positive, mainly craniocervical junction injuries, and confirmed by MRI (28.6%, P < .001 compared with the NPR); no control CCT was interpreted by the PR as positive (sensitivity 100%, positive predictive value 100%, and negative predictive value 58.3%).
Conclusion:
In our retrospective study, a pediatric radiologist has improved recognition of pediatric cervical spine injuries on CT compared with non-pediatric radiologist.
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