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

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FIG 1.
Report comparison of primary and secondary interpretations.
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FIG 2.
Example of a falsely diagnosed fracture on primary interpretation. The referring hospital falsely identified a chip fracture of the right inferior articular facet of C5 (CT images, A and C). MR imaging was performed to assess right upper extremity weakness and did not show any evidence of fracture or ligamentous injury. Axial T1 (B) and sagittal STIR (D).
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FIG 3.
Example of a missed, unstable pattern fracture on the primary interpretation from the referring hospital, which was identified as a C3 teardrop fracture seen in both the coronal (left) and sagittal (right) reformations on the secondary interpretation (arrows). The patient presented with upper extremity weakness and was treated nonoperatively with a cervical collar.

Table 2:

Discordant primary interpretations with false-positives and false-negatives by frequencies of adjudicated injury types^{^a}

Discordant Reports	No.	%
Discordant falsely identified fractures	19/650	3
Discordant falsely identified fractures by type
Facet	6/19	32
Vertebral body	5/19	26
Lamina	4/19	21
Transverse process	2/19	11
Spinous process	1/19	5
Subluxation	1/19	5
C1 arch	1/19	5
Discordant fractures missed on primary interpretation	18/650	2.8
Discordant missed fractures by type
C7 (transverse process, facet, or endplate)	9/18	50
C2 (dens, odontoid, pedicle, transverse foramen, lateral mass)	5/18	28
C4 (spinous process, vertebral body, foramina)	4/18	22
Occipital condyle	2/18	11
C5 (transverse process, foramina)	2/18	11
Teardrop	1/18	5.5
C1 arch	1/18	5.5

↵a Data presented in this table are those of patients with discordant results postadjudication. Note that some cases had multiple cervical spinal fractures.