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Missed cervical spine injuries: aim for the top
Melissa C Werndle1, Julia Myers2, Alexander Mortimer2
1Department of Neuroradiology, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK. Melissa.werndle@gmail.com.
Emergency Radiology
|March 10, 2022
Summary
Radiology registrars have a low error rate when interpreting cervical spine CT scans after trauma. However, missed injuries frequently occur at the cranio-cervical junction, highlighting a critical area for review.
Area of Science:
- Trauma radiology
- Neuroradiology
- Medical imaging analysis
Background:
- Cervical spine injuries require accurate and timely diagnosis.
- Radiology registrars play a crucial role in interpreting trauma imaging.
- Identifying potential areas of diagnostic error is essential for improving patient care.
Purpose of the Study:
- To assess the incidence of missed cervical spine injuries by radiology registrars.
- To identify common blind spots in the interpretation of cervical spine CT scans.
- To evaluate the discrepancy rate between trainee and consultant reports.
Main Methods:
- Retrospective analysis of 573 cervical spine CT scans from trauma patients.
- Inclusion of scans with separate radiology trainee and consultant reports.
- Recording and categorizing registrar errors, including missed fractures and ligamentous injuries.
- Statistical comparison of error rates and injury locations using the chi-square test.
Main Results:
- A total of 149 injuries were identified in 96 patients.
- 12 registrar errors (2.1% discrepancy rate) were noted, with 11 being missed acute injuries.
- Missed injuries disproportionately occurred at the cranio-cervical junction (73% of missed injuries).
- Occipital condyle fractures accounted for 45% of missed injuries.
Conclusions:
- Radiology registrars demonstrate a low discrepancy rate in reporting emergency cervical spine CT scans.
- The cranio-cervical junction is a common site for missed cervical spine injuries.
- The cranio-cervical junction should be designated as a standard review area for trainees.
