Assessment of cervical spine CT scans by emergency physicians: A comparative diagnostic accuracy study in a non‐clinical setting. Issue 1 (20th January 2022)

• Record Type: Journal Article
• Authors: van der Kolk, Brigitta (Britt) Y.M.; van den Wittenboer, Gabriella (Gaby) J.; Warringa, Niek; Nijholt, Ingrid M.; van Hasselt, Boudewijn A.A.M.; Buijteweg, Lonneke N.; Schep, Niels W.L.; Maas, Mario; Boomsma, Martijn F.
• Is Part Of: JACEP open. Volume 3:Issue 1(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-01-20
• Subjects: cervical vertebrae -- computed tomography -- diagnostic accuracy -- emergency medicine -- medical education -- radiology -- spinal injuries -- spine; Medical emergencies -- Periodicals; 616.025
• DOI: 10.1002/emp2.12609
• Languages: English
• ISSNs: 0361-1124

Abstract

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.