Radiology resident educationMemorial award recipientPredicting Radiology Resident Errors in Diagnosis of Cervical Spine Fractures1
Section snippets
Methods
Radiology residents at our institution spend 4 weeks on a dedicated after-hours emergency department (ED) rotation at a level I trauma center. The rotation involves weekday coverage between the hours of 7 pm and 8 am. In addition, 24-hour weekend coverage is also provided by another resident from a call pool. During this rotation, residents perform primary interpretation of radiographs and CT scans primarily, with limited number of magnetic resonance imaging and ultrasound studies. Residents
Results
There were 490 cervical spine fractures in 327 patients (222 male, 105 female; age range 4–98 years, mean age 41.8 years, standard deviation 20.6 years). All patients had a cervical spine CT. The most commonly injured levels were C6 and C7 and the most commonly injured locations were facet/lateral mass followed closely by transverse process and posterior elements (Table 1, Table 2).
There were 59 errors (of 490, 12%) by the after-hours resident. Thirty-five were outright misses, 11 were
Discussion
In this study, we showed that there was a significantly increased risk of residents making errors with upper cervical spine fractures, especially dens or occipital condyle fractures, compared with lower cervical spine injuries. Many of these injuries were subtle alar ligament avulsion injuries. These are either avulsion fractures of the occipital condyle (type 3 occipital condyle fractures) (10) or avulsion fractures of the tip of the dens (type 1 dens fractures) (11). Raising resident
References (30)
- et al.
Distribution and patterns of blunt traumatic cervical spine injury
Ann Emerg Med
(2001) - et al.
Accuracy of interpretations of emergency department radiographseffect of confidence levels
Ann Emerg Med
(1989) - et al.
Proper ROC analysis and joint ROC analysis of the satisfaction of search effect in chest radiology
Acad Radiol
(2000) - et al.
National survey of the incidence of cervical spine injury and approach to cervical spine clearance in US trauma centers
J Trauma
(1999) - et al.
Diagnosis of cervical spine injury in motor vehicle crash victimshow many X-rays are enough?
J Trauma
(1990) - et al.
Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma
N Engl J Med
(2000) - et al.
Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening
Anaesthesia
(2004) - et al.
The Canadian C-spine rule for radiography in alert and stable trauma patients
JAMA
(2001) - Nguyen GK, Clark R. Adequacy of plain radiography in the diagnosis of cervical spine injuries. Emerg Radiol 2004; Nov...
- et al.
The etiology of missed cervical spine injuries
J Trauma
(1993)
Cervical spine injurya clinical decision rule to identify high-risk patients for helical CT screening
AJR Am J Roentgenol
Cervical spine screening in trauma patients with computed tomographya cost-effectiveness analysis
Radiology
Morphology and treatment of occipital condyle fractures
Spine
Fractures of the odontoid process of the axis
J Bone Joint Surg Am
Error in radiologyclassification and lessons in 182 cases presented at a problem case conference
Radiology
Cited by (12)
Clinical relevance of occipital condyle fractures
2020, Journal of Craniovertebral Junction and SpineRisk factors for perceptual-versus-interpretative errors in diagnostic neuroradiology
2019, American Journal of Neuroradiology