Abstract
Purpose
To describe and categorize diagnostic errors in cervical spine CT (CsCT) interpretation performed for trauma and to assess their clinical significance.
Methods
All CsCTs performed for trauma with diagnostic errors that came to our attention based on clinical or imaging follow-up or quality assurance peer review from 2004 to 2017 were included. The number of CsCTs performed at our institution during the same time interval was calculated. Errors were categorized as spinal/extraspinal, involving osseous/soft tissue structures, by anatomical site and level. Images were reviewed by a radiologist and two spine surgeons. For each error, the need for surgery, immobilization, CT angiogram of the neck, and MRI was assessed; if any of these were needed, the error was considered clinically significant.
Results
Of an approximate total 59,000 CsCTs, 56 reports containing diagnostic errors were included. Twelve were extraspinal, and 44 were spinal (26 fractures, 15 intervertebral disc protrusions, two subluxations, one lytic bone lesion). The most common sites of spinal fractures were vertebral body (n = 10) and transverse process (n = 8); the most common levels were C5 (n = 8) and C7 (n = 6). All (n = 26) fractures and two atlantooccipital subluxations were considered clinically significant, including three patients who would have required urgent surgical stabilization (two subluxations and one facet fracture). Two transverse processes fractures did not alter the need for surgical intervention/surgical approach, immobilization, or MRI.
Conclusions
In our study, 66% of spinal diagnostic errors on CsCT were considered clinically significant, potentially altering clinical management. Transverse process and vertebral body fractures were commonly missed.
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Change history
26 April 2019
The published version of this article unfortunately contained a mistake. Author given and family name Alessandrino Francesco was incorrectly interchanged. The correct presentation is given above. The original article has been corrected.
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Alessandrino Francesco, MD: no conflicts of interests.
Christopher M. Bono, MD: North American Spine Society, Editor in Chief Stipend, The Spine Journal; Wolters Kluwer, royalties for edited book; Elsevier, royalties for edited book.
Christopher A. Potter, MD: no conflicts of interests.
Mitchel B. Harris MD: no conflicts of interests.
Aaron D. Sodickson, MD PhD: no conflicts of interests.
Bharti Khurana, MD: book royalties from Cambridge University Press.
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The original version of this article was revised: The published version of this article unfortunately contained a mistake. Author given and family name Alessandrino Francesco was incorrectly interchanged. The correct presentation is given above.
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Alessandrino, F., Bono, C.M., Potter, C.A. et al. Spectrum of diagnostic errors in cervical spine trauma imaging and their clinical significance. Emerg Radiol 26, 409–416 (2019). https://doi.org/10.1007/s10140-019-01685-0
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DOI: https://doi.org/10.1007/s10140-019-01685-0