Spectrum of diagnostic errors in cervical spine trauma imaging and their clinical significance
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To describe and categorize diagnostic errors in cervical spine CT (CsCT) interpretation performed for trauma and to assess their clinical significance.
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.
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.
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.
KeywordsComputed tomography Diagnostic errors Cervical vertebrae Spinal fractures Spinal injuries
Compliance with ethical standards
Conflict of interest
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.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study, formal consent is not required.
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