Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

Zyl, Hendrik P. Van; Bilbey, James H.; Vukusic, Alan; Ring, Todd; Oakes, Jennifer A.; Williamson, Lykke D.; Mitchell, I.V.

doi:10.2310/8000.2013.130978

Cited by 8 publications

(10 citation statements)

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“…Radiology interventions can be non-technological, such as structured reporting [59] or double reading [60] of imaging results, or technological, such as perceptual feedback or attentional guidance [61]. Though these interventions show promise, it is unlikely the majority of emergency department clinicians will reach the same technical standard as radiologists [62]. Thus more prompt secondary reviews of radiographs are also needed to reduce the impact of missed fractures [63].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic error in the emergency department: learning from national patient safety incident report analysis

et al. 2019

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BackgroundDiagnostic error occurs more frequently in the emergency department than in regular in-patient hospital care. We sought to characterise the nature of reported diagnostic error in hospital emergency departments in England and Wales from 2013 to 2015 and to identify the priority areas for intervention to reduce their occurrence.MethodsA cross-sectional mixed-methods design using an exploratory descriptive analysis and thematic analysis of patient safety incident reports. Primary data were extracted from a national database of patient safety incidents. Reports were filtered for emergency department settings, diagnostic error (as classified by the reporter), from 2013 to 2015. These were analysed for the chain of events, contributory factors and harm outcomes.ResultsThere were 2288 cases of confirmed diagnostic error: 1973 (86%) delayed and 315 (14%) wrong diagnoses. One in seven incidents were reported to have severe harm or death. Fractures were the most common condition (44%), with cervical-spine and neck of femur the most frequent types. Other common conditions included myocardial infarctions (7%) and intracranial bleeds (6%). Incidents involving both delayed and wrong diagnoses were associated with insufficient assessment, misinterpretation of diagnostic investigations and failure to order investigations. Contributory factors were predominantly human factors, including staff mistakes, healthcare professionals’ inadequate skillset or knowledge and not following protocols.ConclusionsSystems modifications are needed that provide clinicians with better support in performing patient assessment and investigation interpretation. Interventions to reduce diagnostic error need to be evaluated in the emergency department setting, and could include standardised checklists, structured reporting and technological investigation improvements.

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Section: Discussionmentioning

confidence: 99%

Diagnostic error in the emergency department: learning from national patient safety incident report analysis

et al. 2019

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“…This data set of 417 scans was subsequently divided into 8 subsets (1 subset per emergency physician). Similar to an earlier study by van Zyl et al., 8 a set size of 50 scans per subset was chosen, with a few additional scans per subset to cover for potential missing data. Scans with and without injury were distributed randomly over the subsets, resulting in 8 different subsets with varying injury prevalence (Appendix 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…Additionally, more and more radiology services have been outsourced to external teleradiology services, because of an international shortage of radiologists. 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

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Assessment of cervical spine CT scans by emergency physicians: A comparative diagnostic accuracy study in a non‐clinical setting

et al. 2022

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Objectives To determine and compare the diagnostic accuracy of assessing injuries on cervical spine computed tomography (CT) scans by trained emergency physicians and radiologists, both in a non‐clinical setting. Methods In this comparative diagnostic accuracy study, 411 cervical spine CT scans, of which 120 contained injuries (fractures and/or dislocations), were divided into 8 subsets. Eight emergency physicians received focused training and assessed 1 subset each before and after training. Four radiologists assessed 2 subsets each. Diagnostic accuracy between both groups was compared. The reference standard used was a multiverified data set, assessed by radiologists, neurosurgeons, and emergency physicians. The neurosurgeons also classified whether an "injury in need of stabilizing therapy" (IST) was present. Results Posttraining, the emergency physicians demonstrated increased sensitivity and specificity for identifying cervical spine injuries compared to pretraining: sensitivity 88% (95% confidence interval [CI] 80% to 93%) versus 80% (95% CI 72% to 87%) and specificity 89% (95% CI 85% to 93%) versus 86% (95% CI 81% to 89%). When comparing the trained emergency physicians to the group of radiologists, no difference in sensitivity was found, 88% (95% CI 80% to 83%); however, the radiologists showed a significantly higher specificity ( P < 0.01): 99% (95% CI 96% to 100%). In the 12% (15 scans) with missed injuries, emergency physicians missed more ISTs than radiologists, 6 versus 4 scans; however, this difference was not significant ( P = 0.45). Conclusion After focused training and in a non‐clinical setting, no significant difference was found between emergency physicians and radiologists in ruling out cervical spine injuries; however, the radiologists achieved a significantly higher specificity.

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“…Empfohlen werden die Funktionsaufnahmen abhängig von der neurologischen Symptomatik bestenfalls frühestens 2 Wochen nach dem Trauma und unter ständi-ger Kontrolle in der Durchleuchtung. Es ist eine dringende Empfehlung der Autoren, die gute Zusammenarbeit mit den Unfallchirurgen [37] dazu zu nutzen, die Untersuchung interdisziplinär im Beisein der Unfallchirurgen durchzuführen.…”

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Trauma der Wirbelsäule: erste Hilfe durch Schnittbildverfahren

Schueller¹,

Schueller-Weidekamm²

2014

Radiologe

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The diagnosis of the traumatized spine is one of the key issues for trauma radiologists. The cross-sectional imaging procedures, computed tomography (CT) and magnetic resonance imaging (MRI) are the essential methods in spinal trauma radiology. These modalities are of great help in accurately assessing injury patterns and extent and in providing indications of patient outcome. In contrast to cross-sectional imaging, radiography has a role in the evaluation of minor spinal trauma only. It is generally accepted that trauma radiologists do not use typical classifications to evaluate the spine partly because such an ideal classification system does not yet exist. Not least because of this classification difficulty, eponyms and synonyms are widely used to describe traumatology of the spine as a high level of specific information is included in these various terms. The members of the trauma team should be aware of the strengths and limitations of the methods used in the assessment of the spine. This article provides a brief outline of fundamental knowledge about the diagnosis of spinal trauma.

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Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

Cited by 8 publications

References 12 publications

Diagnostic error in the emergency department: learning from national patient safety incident report analysis

Diagnostic error in the emergency department: learning from national patient safety incident report analysis

Assessment of cervical spine CT scans by emergency physicians: A comparative diagnostic accuracy study in a non‐clinical setting

Trauma der Wirbelsäule: erste Hilfe durch Schnittbildverfahren

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