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2.
Acad Emerg Med ; 22(12): 1465-73, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26576033

ABSTRACT

Computed tomography (CT) scanning is an essential diagnostic tool and has revolutionized care of patients in the acute care setting. However, there is widespread agreement that overutilization of CT, where benefits do not exceed possible costs or harms, is occurring. The goal was to seek consensus in identifying and prioritizing research questions and themes that involve the comparative effectiveness of "traditional" CT use versus alternative diagnostic strategies in the acute care setting. A modified Delphi technique was used that included input from emergency physicians, emergency radiologists, medical physicists, and an industry expert to achieve this.


Subject(s)
Comparative Effectiveness Research/organization & administration , Emergency Service, Hospital/organization & administration , Health Services Research/organization & administration , Tomography, X-Ray Computed/statistics & numerical data , Consensus Development Conferences as Topic , Cost-Benefit Analysis , Delphi Technique , Emergency Medicine , Humans , Tomography, X-Ray Computed/standards
3.
Diagn Interv Radiol ; 21(5): 423-7, 2015.
Article in English | MEDLINE | ID: mdl-26200483

ABSTRACT

PURPOSE: A second opinion is a valuable resource in confirming proper medical diagnosis and treatment. This study evaluates the effectiveness of second-opinion radiology consultations to reassess the cervical spine computed tomography (CT) scans of the trauma patients referred to our hospital. METHODS: Cervical spine CT scans of 301 consecutive adult trauma patients, who were referred to our hospital from outside institutions, were analyzed. The emergency radiologists at our institution completed the over-read reports on the CT images obtained at the outside facilities. A single radiologist compared the outside- and over-read reports and determined the discrepancy of the radiologic reports. RESULTS: Based on the outside reports, 31% of the CT scans had cervical traumatic injury. In 92% of patients, the first-read and the over-read reports had consistent radiologic findings. About 90% of the positive, and 93% of the negative radiologic findings, were reported consistently in the over-read reports. Our analysis showed that the over-read reporting resulted in reassurance of negative findings in 63%; confirmation of positive findings in 29%; clearing a false diagnosis in 3%; and detection of a missed diagnosis in 5%. A rescan was done in 80% of patients with inconsistent and 20% of patients with consistent findings (P < 0.05). The most common missed radiologic findings in the first-reports were transverse and spinous process fractures and the most common misdiagnoses were dens fractures. CONCLUSION: For a service offering second-opinion consultations on cervical spine trauma, review of outside CT studies improves diagnosis and benefits patient care.


Subject(s)
Cervical Vertebrae/diagnostic imaging , Referral and Consultation , Spinal Fractures/diagnosis , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Aged, 80 and over , Diagnostic Errors , Humans , Middle Aged , Reproducibility of Results , Tertiary Care Centers , Young Adult
4.
J Am Coll Radiol ; 12(5): 467-74, 2015 May.
Article in English | MEDLINE | ID: mdl-25622765

ABSTRACT

PURPOSE: The aim of this study was to retrospectively review the growth rate in emergency radiology volume at an urban academic trauma center from 1996 to 2012. METHODS: The authors reviewed aggregated billing data, for which the requirement for institutional review board approval was waived, from 1,458,230 diagnostic radiologic examinations ordered for emergency department (ED) visits from 1996 to 2012. The growth rate was calculated as the average annual percentage change in imaging examinations per ED visits. The growth rates between 1996 to 2003 and 2004 to 2012 were statistically compared using a t test. RESULTS: ED patient visits showed continual growth at an average of 3% per year. Total imaging per ED visit grew from 1996 to 2003 at 4 ± 4% per year but significantly decreased from 2004 to 2012 at -2 ± 3% per year (P = .01). By modality, statistically significant decreased growth was observed in CT and MRI from 2004 to 2012. Ultrasound and x-ray showed unchanged growth from 1996 through 2012. ED physician ultrasound data available for 2002 to 2011 also showed increased growth. CONCLUSIONS: When adjusting ED imaging volume by ED visits, significantly decreased growth of overall ED imaging, specifically CT and MRI, was observed during the past 9 years. This may be due to slowing of new imaging indications, improved awareness of practice guidelines, and increased use of ultrasound. Although the national health care discussion focuses on continual imaging growth, these results demonstrate that long-term stability in ED imaging utilization is achievable.


Subject(s)
Academic Medical Centers/statistics & numerical data , Diagnostic Imaging/statistics & numerical data , Diagnostic Imaging/trends , Emergency Service, Hospital/statistics & numerical data , Emergency Service, Hospital/trends , Trauma Centers/statistics & numerical data , Academic Medical Centers/trends , Boston/epidemiology , Emergency Medical Services/statistics & numerical data , Emergency Medical Services/trends , Trauma Centers/trends , Utilization Review
5.
Emerg Radiol ; 21(6): 615-24, 2014 Dec.
Article in English | MEDLINE | ID: mdl-24828243

ABSTRACT

Abdominal pain is one of the most common reasons for patients to present to the emergency department (ED) in the USA, with an estimated seven million visits in 2007-2008, a figure which represents 8 % (±0.2 %) [2] of all ED visits and a 31.8 % increase from 1999-2000. Abdominal pain has a broad differential diagnosis that encompasses multiple organ systems and can provide a significant diagnostic challenge to the ED physician. Although magnetic resonance imaging (MRI) currently plays a limited role in the assessment of abdominal pain presenting to the ED in the nongravid population, its utility in the pregnant and pediatric population has already been proven. A proven diagnostic track record, lack of ionizing radiation and the ability to provide excellent tissue contrast without the use of nephrotoxic iodinated contrast, makes MRI an attractive imaging modality. As physicians and patients become more aware of the potential risks associated with exposure to ionizing radiation, ED MRI utilization is likely to increase. In this article, we discuss the MRI appearance of some of the most common diagnoses, which present as abdominal pain to the ED.


Subject(s)
Abdominal Pain/diagnosis , Emergency Medical Services , Magnetic Resonance Imaging , Acute Disease , Appendicitis/diagnosis , Cholecystitis/diagnosis , Crohn Disease/diagnosis , Female , Humans , Intestinal Obstruction/diagnosis , Ovarian Diseases/diagnosis , Pancreatitis/diagnosis , Pregnancy , Torsion Abnormality/diagnosis , Urolithiasis/diagnosis
6.
AJR Am J Roentgenol ; 202(4): 725-9, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24660698

ABSTRACT

OBJECTIVE: In patients with suspected pulmonary thromboembolism (PTE), coronary artery calcification (CAC) can be an incidental finding on pulmonary CT angiography. We evaluated the frequency of CAC not being reported and its association with a diagnosis of acute coronary syndrome (ACS). MATERIALS AND METHODS: Data of 469 consecutive patients who were referred to the emergency radiology department for pulmonary CT angiography of suspected PTE were reviewed. Radiology reports were rechecked and positive CAC findings were recorded. All pulmonary CT angiograms were reevaluated by one radiologist and CAC findings were recorded. The rates of ACS and PTE as final diagnoses for that hospital admission were calculated. The association between CAC and ACS diagnosis was assessed in different subgroups of patients. RESULTS: Approximately 11.1% of patients had PTE and 43.8% had CAC. The incidence of CAC was significantly higher in patients with an ACS diagnosis than in those without ACS (56.2% vs 40.4%, respectively; odds ratio [OR] = 1.9). There was a strong positive association (OR = 3.5) between CAC and ACS in younger patients (men ≤ 45 years and women ≤ 55 years), patients without PTE (OR = 2.2), and those without cardiometabolic risk factors (OR = 3.8). CAC was not reported in 45% of patients (n = 98) with positive CAC findings on imaging. ACS was the final diagnosis in 31.6% of patients with unreported CAC. There was a significant association between CAC and ACS in patients with unreported CAC (OR = 2.2). This association was more prominent in the subgroups described. CONCLUSION: CAC is often not reported in pulmonary CT angiography studies. CAC is a significant predictor of ACS particularly in younger patients, patients without PTE, and those without cardiometabolic risk factors. Especially in these subgroups, radiologists should assess CAC findings.


Subject(s)
Acute Coronary Syndrome/diagnostic imaging , Calcinosis/diagnostic imaging , Coronary Angiography/methods , Pulmonary Embolism/diagnostic imaging , Tomography, X-Ray Computed/methods , Acute Coronary Syndrome/epidemiology , Aged , Calcinosis/epidemiology , Female , Humans , Incidence , Incidental Findings , Male , Massachusetts/epidemiology , Middle Aged , Risk Factors
7.
Emerg Radiol ; 21(2): 115-32, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24369342

ABSTRACT

The American Society of Emergency Radiology (ASER) was founded in 1988 and is celebrating its 25th Anniversary. ASER is thriving and emergency radiology has never enjoyed greater popularity than at present. This history describes the genesis of the Society, its growth and current state of affairs. It is based on the recollections and personal files of the authors, one Founder and both former ASER Presidents and Gold Medalists, the ASER archives, and interviews and correspondence with many ASER members. It is hoped that this brief review will be interesting to the reader, provide some insight into ASER evolution over the years, and hold some lessons moving forward.


Subject(s)
Emergency Medicine/history , Radiology/history , Societies, Medical/history , History, 20th Century , History, 21st Century , United States
8.
Ann Emerg Med ; 63(1): 25-32, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24134958

ABSTRACT

Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.


Subject(s)
Emergency Service, Hospital/standards , Practice Guidelines as Topic , Tomography, X-Ray Computed/standards , Brain Injuries/diagnostic imaging , Defensive Medicine/standards , Emergency Service, Hospital/statistics & numerical data , Humans , Tomography, X-Ray Computed/adverse effects , Tomography, X-Ray Computed/statistics & numerical data , United States
9.
J Am Coll Radiol ; 11(1): 36-44, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24135540

ABSTRACT

Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation. This is particularly pertinent to populations in emergency departments, such as children and patients who receive repeated CT scans for benign diagnoses. During the last several decades, among national medical specialty organizations, the American College of Emergency Physicians and the American College of Radiology have each formed membership working groups to consider value, access, and expedience and to promote broad acceptance of CT protocols and procedures within their disciplines. Those efforts have had positive effects on the use criteria for CT by other physician groups, health insurance carriers, regulators, and legislators.


Subject(s)
Emergency Medical Services/standards , Emergency Medicine/standards , Practice Guidelines as Topic , Radiation Protection/standards , Radiology/standards , Tomography, X-Ray Computed/standards , Guideline Adherence , United States
11.
Emerg Med Int ; 2011: 848013, 2011.
Article in English | MEDLINE | ID: mdl-22046549

ABSTRACT

Trauma patients with thoracic aortic injury (TAI) suffer blunt cardiac injury (BCI) at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG) and serum creatine kinase-MB (CK-MB) from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an elevated CK-MB or abnormal echocardiography. There were 26 patients (19 men, mean age 45.1 years, mean ISS 34.4) in the study group; 20 had evidence of BCI. Of 52 patients in the control group (38 men, mean age 46.9 years, mean ISS 38.7), eighteen had evidence of BCI. There was a significantly higher rate of BCI in trauma patients with TAI versus those without TAI (77% versus 35%, P < 0.001).

13.
J Emerg Med ; 40(5): 518-21, 2011 May.
Article in English | MEDLINE | ID: mdl-21269791

ABSTRACT

BACKGROUND: Cervical spine injuries may have devastating neurological consequences, which makes accurate diagnosis of injury a key part of the trauma evaluation. Imaging plays a significant role in making the diagnosis and guiding management. Current American College of Radiology Appropriateness Criteria guidelines recommend computed tomography (CT) of the cervical spine with multi-planar reformats as the highest-rated imaging examination for patients meeting clinical criteria, without subsequent need for further imaging with a negative scan in a neurologically intact and non-obtunded patient. Although CT is fast and accurate for evaluation of bony injury, it may overlook ligamentous injury. OBJECTIVE AND CASE REPORT: We report a case in which ligamentous instability was demonstrated as subluxation with an out-of-collar lateral radiograph after a CT scan showed no subluxation or fracture in a patient without neurological deficits. Our Radiology Department routinely performs an out-of-collar lateral radiograph after a negative CT scan, and this case suggests that there may be an important role for this practice. CONCLUSION: Magnetic resonance is the optimal study for soft tissue and ligamentous evaluation; however, a simple lateral out-of-collar radiograph after CT clearance, in an otherwise neurologically intact and non-obtunded patient, may be a quick and cost-effective means to assess for instability of the cervical spine.


Subject(s)
Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/injuries , Joint Dislocations/diagnostic imaging , Joint Instability/diagnostic imaging , Spinal Injuries/diagnostic imaging , Tomography, X-Ray Computed/methods , Wounds, Nonpenetrating/diagnostic imaging , Accidental Falls , Humans , Male , Middle Aged , Neurologic Examination
14.
Am J Cardiol ; 107(5): 643-50, 2011 Mar 01.
Article in English | MEDLINE | ID: mdl-21247533

ABSTRACT

Newer cardiac computed tomographic (CT) technology has permitted comprehensive cardiothoracic evaluations for coronary artery disease, pulmonary embolism, and aortic dissection within a single breath hold, independent of the heart rate. We conducted a randomized diagnostic trial to compare the efficiency of a comprehensive cardiothoracic CT examination in the evaluation of patients presenting to the emergency department with undifferentiated acute chest discomfort or dyspnea. We randomized the emergency department patients clinically scheduled to undergo a dedicated CT protocol to assess coronary artery disease, pulmonary embolism, or aortic dissection to either the planned dedicated CT protocol or a comprehensive cardiothoracic CT protocol. All CT examinations were performed using a 64-slice dual source CT scanner. The CT results were immediately communicated to the emergency department providers, who directed further management at their discretion. The subjects were then followed for the remainder of their hospitalization and for 30 days after hospitalization. Overall, 59 patients (mean age 51.2 ± 11.4 years, 72.9% men) were randomized to either dedicated (n = 30) or comprehensive (n = 29) CT scanning. No significant difference was found in the median length of stay (7.6 vs 8.2 hours, p = 0.79), rate of hospital discharge without additional imaging (70% vs 69%, p = 0.99), median interval to exclusion of an acute event (5.2 vs 6.5 hours, p = 0.64), costs of care (p = 0.16), or the number of revisits (p = 0.13) between the dedicated and comprehensive arms, respectively. In addition, radiation exposure (11.3 mSv vs 12.8 mSv, p = 0.16) and the frequency of incidental findings requiring follow-up (24.1% vs 33.3%, p = 0.57) were similar between the 2 arms. Comprehensive cardiothoracic CT scanning was feasible, with a similar diagnostic yield to dedicated protocols. However, it did not reduce the length of stay, rate of subsequent testing, or costs. In conclusion, although this "triple rule out" protocol might be helpful in the evaluation of select patients, these findings suggest that it should not be used routinely with the expectation that it will improve efficiency or reduce resource use.


Subject(s)
Chest Pain/diagnostic imaging , Coronary Disease/diagnostic imaging , Emergency Service, Hospital , Tomography, X-Ray Computed/methods , Acute Disease , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reproducibility of Results
15.
AJR Am J Roentgenol ; 196(2): 238-43, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21257870

ABSTRACT

OBJECTIVE: The objective of our study was to prospectively determine how CT affects physicians' diagnostic certainty and management decisions in the setting of patients with nontraumatic abdominal complaints presenting to the emergency department. SUBJECTS AND METHODS: We included 584 patients presenting with nontraumatic abdominal complaints to the emergency department from November 2006 through February 2008. Emergency department clinicians were prospectively surveyed both before abdominal CT (pre-CT) and after abdominal CT (post-CT) to determine the leading diagnosis, the diagnostic certainty, and the management decisions. Changes were assessed by Fisher's exact test and the log likelihood ratio. RESULTS: The most common diagnoses were renal colic (119/584, 20.4%) and intestinal obstruction (80/584, 13.7%). CT altered the leading diagnosis in 49% of the patients (284/584, p < 0.00001) and increased mean physician diagnostic certainty from 70.5% (pre-CT) to 92.2% (post-CT) (p < 0.001; log likelihood ratio, 2.48). The management plan was changed by CT in 42% (244/583) (p < 0.0001). Physicians planned to admit 75.3% of the patients (440/584) to the hospital before CT; that plan was changed to hospital discharge with follow-up in 24.1% of patients (106/440) after CT. Surgery was planned for 79 patients before CT, whereas hospital discharge was planned for 25.3% of these patients (20/79) after CT. CONCLUSION: In the management of patients presenting to the emergency department with nontraumatic abdominal complaints, CT changes the leading diagnosis, increases diagnostic certainty, and changes potential patient management decisions.


Subject(s)
Aortic Aneurysm, Abdominal/diagnostic imaging , Emergency Medical Services/organization & administration , Gastrointestinal Diseases/diagnostic imaging , Pelvic Inflammatory Disease/diagnostic imaging , Radiography, Abdominal/statistics & numerical data , Risk Management/methods , Tomography, X-Ray Computed/statistics & numerical data , Academic Medical Centers , Adolescent , Adult , Aged , Aged, 80 and over , Case Management/organization & administration , Emergency Medical Services/methods , Female , Humans , Intestinal Obstruction/diagnostic imaging , Likelihood Functions , Male , Middle Aged , Models, Organizational , Models, Statistical , Pilot Projects , Population Surveillance , Prospective Studies , Renal Colic/diagnostic imaging , Sensitivity and Specificity , Surveys and Questionnaires , Uncertainty , United States , Young Adult
16.
Radiol Clin North Am ; 49(1): 183-203, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21111135

ABSTRACT

Interpretation of images associated with the traumatically injured face is challenging. The complexity of facial anatomy, coupled with the superimposition of numerous bony structures on plain radiographs, poses specific obstacles to accurate interpretation of facial injury. Although plain radiographs can be helpful in cases of isolated injuries, CT is the most useful modality for evaluating facial injury. This article reviews facial anatomy as it pertains to traumatic injury, emphasizes the clinical findings associated with various types of facial injury, and simplifies the diagnosis of facial injury on CT.


Subject(s)
Imaging, Three-Dimensional/methods , Maxillofacial Injuries/diagnostic imaging , Tomography, X-Ray Computed/methods , Fractures, Bone/diagnostic imaging , Humans
17.
Emerg Radiol ; 18(1): 5-9, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20680653

ABSTRACT

To determine the benefit of a short-term follow-up abdominopelvic computed tomography (APCT) examination among emergency department (ED) patients with persistent abdominal pain and an initially negative CT. During a 5-year period from January 2004 to December 2008, our institution's radiology department performed approximately 56,000 APCTs examinations in the ED. Sixty-eight percent of the APCT examinations used intravenous contrast. Nine hundred fifty-seven patients received two APCTs within 1 week for non-traumatic abdominal pain in the ED. Sixty-four patients with initially negative APCTs presented to the ED within 1 week with persistent abdominal pain and received follow-up APCT imaging. The mean follow-up period was 2.6 days. The mean interval period in which the second APCT yielded a positive result was 2.0 days. Seventy-five percent of follow-up examinations were performed with intravenous contrast. Twenty-three percent of patients had positive findings on the follow-up examination. Seventy-three percent of the follow-up positive findings were referable to bowel pathology. The cause of abdominal pain remained elusive at 1 week in 23% of patients. Short-term follow-up APCT examinations in patients with persistent, unexplained abdominal pain may be of benefit if the second APCT is performed with intravenous contrast in patients suspected of having bowel pathology.


Subject(s)
Abdominal Pain/diagnostic imaging , Emergency Service, Hospital , Tomography, X-Ray Computed , Contrast Media , Humans , Retrospective Studies
19.
Arch Surg ; 145(5): 452-5, 2010 May.
Article in English | MEDLINE | ID: mdl-20479343

ABSTRACT

HYPOTHESIS: In contrast to previous beliefs, we hypothesize that computed tomography (CT) scanning is sensitive and specific for the diagnosis of necrotizing soft tissue infections (NSTIs). DESIGN: Retrospective and prospective case series. SETTING: Academic medical center. PATIENTS: Patients who were clinically suspected of having NSTIs from January 1, 2003, through April 30, 2009, and who underwent imaging with a 16- or 64-section helical CT scanner were studied. The CT result was considered positive if inflamed and necrotic tissue with or without gas or fluid collections across tissue planes was found. The disease (NSTI) was considered present if surgical exploration revealed elements of infection and necrosis of the soft tissues and pathological analysis confirmed the findings. The disease was considered absent if surgical exploration and pathological analysis failed to identify any of these findings or the patient was successfully treated without surgical exploration. MAIN OUTCOME MEASURES: Sensitivity and specificity of CT for diagnosing NSTI. RESULTS: Of 67 patients with study inclusion criteria, 58 underwent surgical exploration, and NSTI was confirmed in 25 (43%). The remaining 42 patients had either nonnecrotizing infections during surgical exploration (n = 33) or were treated nonoperatively with successful resolution of the symptoms (n = 9). The sensitivity of CT to identify NSTI was 100%, specificity was 81%, positive predictive value was 76%, and negative predictive value was 100%. No differences were found in demographics, white blood cell count on admission, symptoms, or site of infection between those with a false- or true-positive CT result. CONCLUSIONS: A negative CT result reliably excludes the diagnosis of NSTI. A positive CT result correctly identifies the disease with a high likelihood.


Subject(s)
Fascia/pathology , Muscles/pathology , Soft Tissue Infections/diagnostic imaging , Subcutaneous Tissue/pathology , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Cohort Studies , Fascia/diagnostic imaging , Female , Humans , Male , Middle Aged , Muscles/diagnostic imaging , Necrosis/diagnostic imaging , Necrosis/pathology , Necrosis/surgery , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Soft Tissue Infections/pathology , Soft Tissue Infections/surgery , Subcutaneous Tissue/diagnostic imaging , Young Adult
20.
Emerg Radiol ; 17(3): 191-3, 2010 May.
Article in English | MEDLINE | ID: mdl-19730903

ABSTRACT

Trauma patients with low clinical suspicion of cervical spine fracture are often examined with a plain X-ray cervical spine series rather than with cervical spine computed tomography (CT). The authors have been concerned by the absence of fractures in the group of patients examined with plain X-ray. The objective of this investigation was to determine the usefulness of plain X-ray examinations in suspected cases of cervical spine fracture compared to CT. A retrospective review was performed of all trauma patients undergoing imaging for suspected cervical spine fracture in our Emergency Department over a one-year period (January 1, 2007 to December 31, 2007). During the study period, 254 cervical spine plain X-ray and 3,080 cervical spine CT examinations were performed. Of the 254 plain X-ray examinations, 237 were interpreted as negative for fracture, 11 were suboptimal examinations, and six were interpreted as possible fractures (later ruled out by further imaging). Of the 3,080 CT examinations, 2,884 were interpreted as negative for fracture and 196 as positive. The overall positivity rates for acute cervical spine fracture were 0.0% in plain X-ray and 6.4% in CT examinations. These data confirm the authors' concern that plain X-ray imaging for patients with low clinical suspicion for cervical spine trauma in our hospital may have too low a yield to justify its use. However, the 6.4% positivity rate in the group of patients selected for CT examination justifies its use in this group.


Subject(s)
Cervical Vertebrae/diagnostic imaging , Spinal Fractures/diagnostic imaging , Cervical Vertebrae/injuries , Diagnostic Errors , Emergency Medicine , Humans , Magnetic Resonance Imaging , Physical Examination , Retrospective Studies , Tomography, X-Ray Computed , X-Rays
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