Accuracy and Clinical Utility of Reports from Outside Hospitals for CT of the Cervical Spine in Blunt Trauma.
Journal
AJNR. American journal of neuroradiology
ISSN: 1936-959X
Titre abrégé: AJNR Am J Neuroradiol
Pays: United States
ID NLM: 8003708
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
31
03
2021
accepted:
18
08
2021
pubmed:
6
11
2021
medline:
3
3
2022
entrez:
5
11
2021
Statut:
ppublish
Résumé
Multidetector CT is the workhorse for detecting blunt cervical spine injury. There is no standard of care for re-interpretation of radiology images for patients with blunt trauma transferred to a higher level of care. The clinical impact of discrepancies of cervical spine CT reads remains unclear. We evaluated the discordance between primary (from referring hospitals) and secondary radiology interpretations (from a receiving level I tertiary trauma center) of cervical spine CT scans in patients with blunt trauma and assessed the clinical implications of missed cervical spine fractures. Medical records of patients with blunt trauma transferred to our institution between 2008 and 2015 were reviewed. Primary and secondary interpretations were compared and categorized as concordant and discordant. Two senior neuroradiologists adjudicated discordant reports. The benefit of re-interpretation was determined. For discordant cases, outcomes at discharge, injury severity pattern, treatment, and arrival in a cervical collar were assessed. Six hundred fifty patients were included; 608 (94%) presented with concordant reports: 401 (61.7%) with fractures and 207 (31.8%) with no fractures. There were 42 (6.5%) discordant reports; 18 (2.8%) were cervical spine injuries undetected on the primary interpretation. Following adjudication, the secondary interpretation improved the sensitivity (99.3% versus 95.7%) and specificity (99.1% versus 91.7%) in detecting cervical spine fractures compared with the primary interpretation alone ( There was an overall 6.5% discordance rate between primary and secondary interpretations of cervical spine CT scans. The secondary interpretation of the cervical spine CT increased the sensitivity and specificity of detecting cervical spine fractures in patients with blunt trauma transferred to higher-level care.
Sections du résumé
BACKGROUND AND PURPOSE
Multidetector CT is the workhorse for detecting blunt cervical spine injury. There is no standard of care for re-interpretation of radiology images for patients with blunt trauma transferred to a higher level of care. The clinical impact of discrepancies of cervical spine CT reads remains unclear. We evaluated the discordance between primary (from referring hospitals) and secondary radiology interpretations (from a receiving level I tertiary trauma center) of cervical spine CT scans in patients with blunt trauma and assessed the clinical implications of missed cervical spine fractures.
MATERIALS AND METHODS
Medical records of patients with blunt trauma transferred to our institution between 2008 and 2015 were reviewed. Primary and secondary interpretations were compared and categorized as concordant and discordant. Two senior neuroradiologists adjudicated discordant reports. The benefit of re-interpretation was determined. For discordant cases, outcomes at discharge, injury severity pattern, treatment, and arrival in a cervical collar were assessed.
RESULTS
Six hundred fifty patients were included; 608 (94%) presented with concordant reports: 401 (61.7%) with fractures and 207 (31.8%) with no fractures. There were 42 (6.5%) discordant reports; 18 (2.8%) were cervical spine injuries undetected on the primary interpretation. Following adjudication, the secondary interpretation improved the sensitivity (99.3% versus 95.7%) and specificity (99.1% versus 91.7%) in detecting cervical spine fractures compared with the primary interpretation alone (
CONCLUSIONS
There was an overall 6.5% discordance rate between primary and secondary interpretations of cervical spine CT scans. The secondary interpretation of the cervical spine CT increased the sensitivity and specificity of detecting cervical spine fractures in patients with blunt trauma transferred to higher-level care.
Identifiants
pubmed: 34737184
pii: ajnr.A7337
doi: 10.3174/ajnr.A7337
pmc: PMC8805756
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2254-2260Informations de copyright
© 2021 by American Journal of Neuroradiology.
Références
AJR Am J Roentgenol. 2020 Apr;214(4):843-852
pubmed: 32023121
Radiology. 2004 Apr;231(1):190-7
pubmed: 15068948
J Am Coll Radiol. 2016 Sep;13(9):1096-101
pubmed: 27012731
Diagn Interv Radiol. 2015 Sep-Oct;21(5):423-7
pubmed: 26200483
Radiology. 2011 Aug;260(2):408-13
pubmed: 21507903
Radiographics. 2018 Oct;38(6):1845-1865
pubmed: 30303801
J Am Coll Radiol. 2009 Sep;6(9):626-32
pubmed: 19720357
Emerg Radiol. 2012 Oct;19(5):447-54
pubmed: 22527362
Emerg Radiol. 2018 Apr;25(2):169-173
pubmed: 29282579
Ann Emerg Med. 2001 Jul;38(1):17-21
pubmed: 11423806
Radiographics. 2014 Nov-Dec;34(7):1842-65
pubmed: 25384284
AJR Am J Roentgenol. 2019 Oct;213(4):W180-W184
pubmed: 31237433
Emerg Radiol. 2014 Oct;21(5):479-84
pubmed: 24777574
Ann Emerg Med. 2011 Nov;58(5):452-62.e3
pubmed: 21835499
J Am Coll Radiol. 2018 Sep;15(9):1222-1231
pubmed: 30031614
Epidemiology. 2007 Nov;18(6):800-4
pubmed: 18049194
Am J Emerg Med. 2015 Nov;33(11):1630-4
pubmed: 26349778
Epidemiology. 2007 Nov;18(6):805-35
pubmed: 18049195
Emerg Radiol. 2006 Oct;13(1):25-30
pubmed: 16900352
AJR Am J Roentgenol. 2012 Mar;198(3):628-34
pubmed: 22358003
J Trauma Acute Care Surg. 2012 Apr;72(4):975-81
pubmed: 22491614
West J Emerg Med. 2017 Aug;18(5):835-845
pubmed: 28874935