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

Brigitta Britt Y M van der Kolk ^1 2 3, Gabriella Gaby J van den Wittenboer ¹, Niek Warringa ², Ingrid M Nijholt ², Boudewijn A A M van Hasselt ², Lonneke N Buijteweg ¹, Niels W L Schep ⁴, Mario Maas ^3 5, Martijn F Boomsma ²Affiliations expand

• PMID: 35079729
• PMCID: PMC8776040
• DOI: 10.1002/emp2.12609

Abstract

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.

Keywords: cervical vertebrae; computed tomography; diagnostic accuracy; emergency medicine; medical education

• PMID: 35079729
• PMCID: PMC8776040
• DOI: 10.1002/emp2.12609

Editor do blog: Julio Pereira – Neurocirugião – São Paulo CRM/SP 163.113 Site para Consulta: https://www.julio-pereira.com/ Consultório: (11)99503-8838 (WhatsApp) / (11)4200-2300 Atuando no Hospital Sírio-Libanês e na BP – A Beneficência Portuguesa de São Paulo.

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