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Pediatric cervical spine injuries on CT: difference in accuracy of interpretations by pediatric versus non-pediatric radiologists

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Abstract

Purpose

To retrospectively compare the accuracy of interpretation of initial cervical computerized tomography (CCT) by a non-pediatric radiologist (NPR) versus a pediatric radiologist (PR).

Methods

IRB approval and consent waiver were granted to review all injured children from 2010 to 2014 in the trauma registry with CT and magnetic resonance imaging (MRI) of the cervical spine. Patients with negative CCT who subsequently had positive MRI from a single institution comprised the study group. Patients with negative CCT and MRI, matched by age, gender, and severity scores, comprised the control group. The CCTs from both groups were initially interpreted at the time of service by a NPR. Subsequently, a single PR with 20 years of experience blinded to clinical/imaging data reinterpreted these CCT examinations. CT interpretations were then compared with MRI results and evaluated for statistical significance using SSPS software. The data analysis utilized summary statistics, two-tailed binomial test, and univariate χ2 test. Significance for all comparisons was assessed at P < 0.05.

Results

The study group was comprised of the 21 patients with negative CCT and positive MRI. Of the cohort included, 76% (16) were male and 24% (5) were female. The age range was 1 month–17 years, with a mean age of 9.7 years. CCT interpretation by NPR had a specificity of 91.7% (sensitivity 71.2%, positive predictive value 81.3%, and negative predictive value 86.3%) compared with results of MRI. Six of the 21 negative CCTs were interpreted by the PR as positive, mainly craniocervical junction injuries, and confirmed by MRI (28.6%, P < .001 compared with the NPR); no control CCT was interpreted by the PR as positive (sensitivity 100%, positive predictive value 100%, and negative predictive value 58.3%).

Conclusion

In our retrospective study, a pediatric radiologist has improved recognition of pediatric cervical spine injuries on CT compared with non-pediatric radiologist.

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Abbreviations

CCT:

Cervical computed tomography

CSI:

Cervical spine injuries

ISS:

Injury Severity Score

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

NPR:

Non-pediatric radiologists

PR:

Pediatric radiologist

PPV:

Positive predictive value

References

  1. Gargas J, Yaszay B, Kruk P, Bastrom T, Shellington D, Khanna S (2013) An analysis of cervical spine magnetic resonance imaging findings after normal computed tomographic imaging findings in pediatric trauma patients: ten-year experience of a level I pediatric trauma center. J Trauma Acute Care Surg 74:1102–1107

    Article  Google Scholar 

  2. Stiell IG, Clement C, Mcknight RD, Brison R, Schull MJ et al (2003) The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in patients with trauma. NEJM 349:2510–2518

    Article  CAS  Google Scholar 

  3. Ehrlich P, Wee C, Drongowski R, Rana A (2009) Canadian C-spine Rule and the National X-Radiography Utilization Low-Risk Criteria for C-spine radiography in young trauma patients. J Pediatr Surg 44:987–991

    Article  Google Scholar 

  4. Leonard JC, Kuppermann N, Olsen C, Cimpello L, Brown KM et al (2011) Factors associated with cervical spine injury in children following blunt trauma. Ann Emerg Med 58:145–155

    Article  Google Scholar 

  5. Sickles EA, Wolverton DE, Dee KE (2002) Performance parameters for screening and diagnostic mammography: specialist and general radiologists. Radiology 224:861–869

    Article  Google Scholar 

  6. Karmazyn B, Wanner MR, Marine MB, Tilmans L, Jennings SG, Hibbard RA (2019) The added value of a second read by pediatric radiologists for outside skeletal surveys. Pediatr Radiol 49:203–209

    Article  Google Scholar 

  7. Eakins C, Ellis WD, Pruthi S, Johnson DP, Hernanz-Schulman M, Yu C, Kan JH (2012) Second opinion interpretations by specialty radiologists at a pediatric hospital: rate of disagreement and clinical implications. Am J Roentgenol 199:916–920

    Article  Google Scholar 

  8. Mullerad M, Hricak H, Wang L, Chen HN, Kattan MW, Scardino PT (2004) Prostate cancer: detection of extracapsular extension by genitourinary and general body radiologists at MR imaging. Radiology 232:140–146

    Article  Google Scholar 

  9. Kihiczak D, Novelline RA, Lawrason JN (2001) Should an MR scan be performed routinely after normal clearance CT scan in the trauma patient? Experience with 59 cases. Emerg Radiol 8:276–278

    Article  Google Scholar 

  10. Hanson JA, Blackmore CC, Mann FA, Wilson AJ (2000) Cervical spine injury: accuracy of helical CT used as a screening technique. Emerg Radiol 7:31–35

    Article  Google Scholar 

  11. Schoenfeld AJ, Bono CM, McGuire KJ, Warholic N, Harris MB (2010) Computed tomography alone versus computed tomography and magnetic resonance imaging in the identification of occult injuries to the cervical spine: a meta-analysis. J Trauma 68:109–114

    Article  Google Scholar 

  12. Alessandrino F, Bono CM, Poffer CA, Harris MB, Sodickson A (2019) Spectrum of diagnostic errors in cervical spine trauma imaging and their clinical significance. Emerg Radiol 26:409–416

    Article  Google Scholar 

  13. Muhm M, Danko T, Henzler T, Luiz T, Winkler H, Ruffing T (2015) Pediatric trauma care with computed tomography-criteria for CT scanning. Emerg Radiol 22:613–621

    Article  Google Scholar 

  14. Yan YY, Khoo JN, Tan TJ, Francis J, Chong LR, Chan EH (2018) Reporting of CT cervical spine after office hours by radiology trainees-analysis of discrepancy rates and RADPEER scores. Emerg Radiol 25:399–406

    Article  Google Scholar 

  15. Junewick JJ, Meesa IR, Luttenton CR, Hinman JM (2009) Occult injury of the pediatric craniocervical juntion. Emerg Radiol 16:483–488

    Article  Google Scholar 

  16. Arenson RL (2018) Factors affecting interpretative accuracy: how can we reduce errors? Radiology 287:213–214

    Article  Google Scholar 

  17. Onwubiko C, Mooney DP (2016) The value of official reinterpretation of trauma computed tomography scans from referring hospitals. J Pediatr Surg 51:486–489

    Article  Google Scholar 

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Acknowledgments

The authors acknowledge the assistance of Beyond Words, Inc., in the editing and preparation of this manuscript.

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Authors and Affiliations

  1. Division of Pediatric Critical Care, OSF Healthcare Children’s Hospital of Illinois, 530 NE Glen Oak Ave, Peoria, IL, 61637, USA

    Nabil Hassan

  2. Mercy Medical Center, P.O. Box 14584, Des Moines, IA, 50306-3584, USA

    Chloe Butler

  3. Department of Surgery, Helen DeVos Children’s Hospital, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA

    James DeCou, Teri Crumb & Stephanie Flohr

  4. Department of Epidemiology, Grand Valley State University, A-1-178 Mackinac Hall, Allendale, MI, 49401, USA

    Diann Reischman

  5. Advanced Radiology Services PC, Grand Rapids, MI, USA

    Joseph Junewick

  6. Michigan State University College of Human Medicine, Grand Rapids, MI, USA

    Joseph Junewick

  7. Department of Radiology, Helen DeVos Children’s Hospital, 100 Michigan Street, Grand Rapids, MI, 49503, USA

    Joseph Junewick

Authors
  1. Nabil Hassan
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  2. Chloe Butler
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  3. James DeCou
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  4. Teri Crumb
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  7. Joseph Junewick
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Corresponding author

Correspondence to Joseph Junewick.

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The authors declare that they have no conflict of interest.

IRB statement

The study received Institutional Review Board approval. A waiver of informed consent was granted for this retrospective study.

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The authors maintained control over the direction and content of this article during its development. Although Beyond Words, Inc., supplied professional editing services, this does not indicate its endorsement of, agreement with, or responsibility for the content of the manuscript.

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Hassan, N., Butler, C., DeCou, J. et al. Pediatric cervical spine injuries on CT: difference in accuracy of interpretations by pediatric versus non-pediatric radiologists. Emerg Radiol 27, 185–190 (2020). https://doi.org/10.1007/s10140-019-01743-7

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  • DOI: https://doi.org/10.1007/s10140-019-01743-7

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