A review of cervical-spine radiographs in casualty patients

This study reviews the radiographs and clinical case notes of 897 patients who attended the Accident and Emergency (A & E) Department of Leicester Royal Infirmary, over an 8-month period, for whom radiographs of the cervical spine were requested. The radiological interpretations by the casualty officers and junior radiologists in training were compared with those by a consultant radiologist and large discrepancies were observed. There was a predominance of fractures and subluxations at the levels of C1 and C2, and at C7 and T1. A study of the adequacy of the radiographs has shown that 90% of the lateral radiographs included C7 but only 57% included T1. Through-the-mouth views were adequate for interpretation in 67% of cases. The practice of the A & E and radiology departments at the Leicester Royal Infirmary is briefly described. The poor performance of the casualty officers and junior radiologists is discussed and suggestions made which might improve the accuracy of the radiological diagnosis of cervical-spine injuries in the A & E department.