Accuracy and Clinical Utility of Reports from Outside Hospitals for CT of the Cervical Spine in Blunt Trauma

K Rao; J M Engelbart; J Yanik; J Hall; S Swenson; B Policeni; J Maley; C Galet; T Granchi; D A Skeete

doi:10.3174/ajnr.A7337

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Accuracy and Clinical Utility of Reports from Outside Hospitals for CT of the Cervical Spine in Blunt Trauma

Journal article

Open access

Peer reviewed

Accuracy and Clinical Utility of Reports from Outside Hospitals for CT of the Cervical Spine in Blunt Trauma

K Rao, J M Engelbart, J Yanik, J Hall, S Swenson, B Policeni, J Maley, C Galet, T Granchi and D A Skeete

American journal of neuroradiology : AJNR, Vol.42(12), pp.2254-2260

12/2021

DOI: 10.3174/ajnr.A7337

PMCID: PMC8805756

PMID: 34737184

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Abstract

Multidetector CT is the workhorse for detecting blunt cervical spine injury. There is no standard of care for re-interpretation of radiology images for patients with blunt trauma transferred to a higher level of care. The clinical impact of discrepancies of cervical spine CT reads remains unclear. We evaluated the discordance between primary (from referring hospitals) and secondary radiology interpretations (from a receiving level I tertiary trauma center) of cervical spine CT scans in patients with blunt trauma and assessed the clinical implications of missed cervical spine fractures. Medical records of patients with blunt trauma transferred to our institution between 2008 and 2015 were reviewed. Primary and secondary interpretations were compared and categorized as concordant and discordant. Two senior neuroradiologists adjudicated discordant reports. The benefit of re-interpretation was determined. For discordant cases, outcomes at discharge, injury severity pattern, treatment, and arrival in a cervical collar were assessed. Six hundred fifty patients were included; 608 (94%) presented with concordant reports: 401 (61.7%) with fractures and 207 (31.8%) with no fractures. There were 42 (6.5%) discordant reports; 18 (2.8%) were cervical spine injuries undetected on the primary interpretation. Following adjudication, the secondary interpretation improved the sensitivity (99.3% versus 95.7%) and specificity (99.1% versus 91.7%) in detecting cervical spine fractures compared with the primary interpretation alone ( < .001). There was an overall 6.5% discordance rate between primary and secondary interpretations of cervical spine CT scans. The secondary interpretation of the cervical spine CT increased the sensitivity and specificity of detecting cervical spine fractures in patients with blunt trauma transferred to higher-level care.

Cervical Vertebrae - diagnostic imaging

Cervical Vertebrae - injuries

Hospitals

Humans

Retrospective Studies

Spinal Injuries - diagnostic imaging

Tomography, X-Ray Computed - methods

Wounds, Nonpenetrating - diagnostic imaging

Details

Title: Subtitle: Accuracy and Clinical Utility of Reports from Outside Hospitals for CT of the Cervical Spine in Blunt Trauma
Creators: K Rao - From the Departments of Radiology (K.R., B.P., J.M.).
J M Engelbart - Giesecke and Devrient (Germany)
J Yanik - University of Iowa
J Hall - University of Iowa
S Swenson - University of Iowa
B Policeni - From the Departments of Radiology (K.R., B.P., J.M.).
J Maley - From the Departments of Radiology (K.R., B.P., J.M.).
C Galet - Surgery (J.M.E., C.G., T.G., D.A.S.), Acute Care Surgery Division.
T Granchi - Surgery (J.M.E., C.G., T.G., D.A.S.), Acute Care Surgery Division.
D A Skeete - Surgery (J.M.E., C.G., T.G., D.A.S.), Acute Care Surgery Division dionne-skeete@uiowa.edu.
Resource Type: Journal article
Publication Details: American journal of neuroradiology : AJNR, Vol.42(12), pp.2254-2260
DOI: 10.3174/ajnr.A7337
PMID: 34737184
PMCID: PMC8805756
NLM abbreviation: AJNR Am J Neuroradiol
ISSN: 0195-6108
eISSN: 1936-959X
Language: English
Date published: 12/2021
Academic Unit: Radiology; Oral Pathology, Radiology and Medicine; Management and Entrepreneurship ; Surgery; Injury Prevention Research Center; University of Iowa Health Care; Otolaryngology; Internal Medicine
Record Identifier: 9984311438602771

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