Spectrum of diagnostic errors in cervical spine trauma imaging and their clinical significance

Alessandrino, Francesco; Bono, Christopher M.; Potter, Christopher; Harris, Mitchel B.; Sodickson, Aaron D; Khurana, Bharti

doi:10.1007/s10140-019-01685-0

Cited by 16 publications

(7 citation statements)

References 30 publications

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“…Allesandrino and colleagues reported a very low (56 out of 59000) but signi cant incidence of missed cervical spine injuries on initial reporting by radiologists between 2004 and 2017. Some of these injuries may have a clinical signi cance (19). However, what is not clear is either the rate of missed diagnosis over time related to changes in CT multi slice row technology.…”

Section: Discussionmentioning

confidence: 99%

Cervical Spine Clearance on Trauma Intensive Care: Can We Trust a Negative CT Scan?

Hasandarras

Strandvik

Faramawy

et al. 2021

Preprint

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Background: Cervical spine clearance in intubated victims of blunt trauma remains contentious; accumulating high level evidence suggests that a normal CT cervical spine can be used to clear the c-spine and remove the collar in obtunded emergency department patients to prevent collar-related complications. However, it is unclear whether this holds true for intubated patients in the trauma intensive care unit (TICU).Methods: We performed a retrospective review of 730 intubated trauma patients who presented to the Level 1 Trauma center of a tertiary hospital. We reviewed the rate of missed cervical injuries in patients who had their cervical collars removed based on a normal computed tomography (CT) scan of the cervical spine, as well as rates of collar-related complications.Results: Three hundred and fifty patients had their cervical collars removed in the TICU based on the findings of a high-quality, well-interpreted normal CT cervical spine. Seventy percent of patients were intubated and sedated at the time of collar removal. Fifty-one percent of patients had concomitant traumatic brain injury. The average GCS at time of collar removal was 9. The incidence of missed neurological injury discerned clinically at time of both ICU and hospital discharge was nil (negative predictive value 100%). The rate of collar-related complications was 2%.Conclusion: Based on our findings, it is safe to remove the cervical collar for patients in the TICU following normal CT cervical spine, provided certain quality conditions related to the CT scan are met. Not removing the collar early may be related to increased complications. We provide an algorithm to assist critical-care clinicians in decision-making in this patient cohort

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Section: Discussionmentioning

confidence: 99%

Cervical Spine Clearance on Trauma Intensive Care: Can We Trust a Negative CT Scan?

Hasandarras

Strandvik

Faramawy

et al. 2021

Preprint

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“…14 C-spine fractures occur in only 2% to 6% of trauma patients, but these must be thoroughly evaluated or ruled out because of their association with high morbidity and mortality. 15 Thoracolumbar spinal fractures are more common, accounting for 50% to 60% of all spinal injuries. 16 Most spine fractures are associated with high-energy trauma or falls in the elderly.…”

Section: Spine Evaluation In Trauma Patientsmentioning

confidence: 99%

Imaging Considerations in Musculoskeletal Trauma

Merton¹

2020

The Journal for Nurse Practitioners

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“…15 Cervical spine injury can be associated with high morbidity and mortality, 16 and a delay in diagnosis of an unstable fracture leading to inadequate immobilization may result in a catastrophic decline in neurologic function with devastating consequences. [17][18][19][20] Clearing the cervical spine through imaging is therefore a critical first step in the evaluation of patients with trauma, and multidetector CT has emerged as the standard of care imaging technique to evaluate cervical spine trauma. 21 Morbidity and mortality in patients with cervical spine injury can be reduced through rapid diagnosis and intervention.…”

mentioning

confidence: 99%

CT Cervical Spine Fracture Detection Using a Convolutional Neural Network

Small¹,

Osler

Paul³

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Multidetector CT has emerged as the standard of care imaging technique to evaluate cervical spine trauma. Our aim was to evaluate the performance of a convolutional neural network in the detection of cervical spine fractures on CT. MATERIALS AND METHODS:We evaluated C-spine, an FDA-approved convolutional neural network developed by Aidoc to detect cervical spine fractures on CT. A total of 665 examinations were included in our analysis. Ground truth was established by retrospective visualization of a fracture on CT by using all available CT, MR imaging, and convolutional neural network output information. The OE coefficients, sensitivity, specificity, and positive and negative predictive values were calculated with 95% CIs comparing diagnostic accuracy and agreement of the convolutional neural network and radiologist ratings, respectively, compared with ground truth. RESULTS:Convolutional neural network accuracy in cervical spine fracture detection was 92% (95% CI, 90%-94%), with 76% (95% CI, 68%-83%) sensitivity and 97% (95% CI, 95%-98%) specificity. The radiologist accuracy was 95% (95% CI, 94%-97%), with 93% (95% CI, 88%-97%) sensitivity and 96% (95% CI, 94%-98%) specificity. Fractures missed by the convolutional neural network and by radiologists were similar by level and location and included fractured anterior osteophytes, transverse processes, and spinous processes, as well as lower cervical spine fractures that are often obscured by CT beam attenuation. CONCLUSIONS:The convolutional neural network holds promise at both worklist prioritization and assisting radiologists in cervical spine fracture detection on CT. Understanding the strengths and weaknesses of the convolutional neural network is essential before its successful incorporation into clinical practice. Further refinements in sensitivity will improve convolutional neural network diagnostic utility.

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Spectrum of diagnostic errors in cervical spine trauma imaging and their clinical significance

Cited by 16 publications

References 30 publications

Cervical Spine Clearance on Trauma Intensive Care: Can We Trust a Negative CT Scan?

Cervical Spine Clearance on Trauma Intensive Care: Can We Trust a Negative CT Scan?

Imaging Considerations in Musculoskeletal Trauma

CT Cervical Spine Fracture Detection Using a Convolutional Neural Network

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