Delayed or missed diagnosis of cervical spine injuries.

BACKGROUND Correct diagnosis of cervical spine injuries is still a common problem in traumatology. The incidence of delayed diagnosis ranges from 5 to 20%. The aim of this study was to analyze the frequency and reasons for delayed or missed diagnosis at this Level I trauma unit and to provide recommendations for optimal examination of patients with suspected cervical spine injuries. METHODS Analysis of clinical records showed 367 patients with cervical spine injuries who were admitted to this trauma department between 1980 and 2000. In all, 140 patients had an injury of the upper cervical spine (C1/C2), 212 patients had an injury of the lower cervical spine (C3-C7), and 15 patients had a combined injury of the upper and lower cervical spine. RESULTS The diagnostic failure rate was 4.9% (n = 18). Results showed several profound reasons for missed or delayed diagnosis. In eight patients (44%), radiologic misinterpretation was responsible for delay in diagnosis; in five patients (28%), incomplete sets of radiographs were responsible. In four cases (22%), the injury was missed because inadequate radiographs did not show the level of the injury; in one case (6%), the treating surgeon did not see the radiographs. CONCLUSION For optimal examination of patients with suspected cervical spine injuries, we recommend establishing specific diagnostic algorithms including complete sets of proper radiographs with functional flexion/extension views, secondary evaluation of the radiographs by experienced staff, and further radiologic examinations (computed tomography, magnetic resonance imaging) if evaluation of standard views is difficult.