The FIST Study: Exploring Clinical Strength of Cervical Spine CT in Determining Need for Stabilizing Treatment in Cervical Spine Injury

Kolk, B. Y. M. van der; Nijholt, Ingrid M.; Podlogar, Martin; Bouma, Gerrit J.; Brink, W. A. van den; Buijteweg, L. N.; Hasselt, Boudewijn A.A.M. van; Schep, Niels W. L.; Maas, Mario; Boomsma, Martijn F.

doi:10.1055/s-0039-1692557

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“…The clinical reference data set also contained information on which injuries qualified for stabilizing therapy (injury in need of stabilizing therapy [IST]), based on the opinion of the neurosurgeons and the actually provided therapy. 15 As such, the reference standard also encompassed information on clinically important injuries. Stabilizing therapy…”

Section: The Bottom Linementioning

confidence: 99%

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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Section: The Bottom Linementioning

confidence: 99%