The misdiagnosis of acute cervical spine injuries and fractures in infants and children: the 12-year experience of a level I pediatric and adult trauma center

Abstract

Objective: The objective was to determine the frequency of acute cervical spine injuries and fractures that were misdiagnosed in infants and children (< or =14 years) initially evaluated at a pediatric and adult urban level I trauma center.

Methods and results: This was a retrospective, single-institution, case series of pediatric cervical spine injuries and fractures that were misdiagnosed during initial emergency room imaging evaluation. "Misdiagnosed" cases were those cases whose imaging studies initially obtained in the emergency room were misinterpreted based on reevaluation by a senior trauma radiologist blinded to the initial results. Nineteen percent (7 out of 37) were misdiagnosed on initial emergency room imaging evaluation. Five percent were true "missed" fractures, and 14% were "normal and/or developmental variants" read as fractures or dislocation.

Conclusions: The error rate for infants and children < or =8 years was 24%, and for children > or =9 years was 15%. The occiput to C2 region was the most common site of diagnostic error. The most common factors predisposing to misdiagnosis were unfamiliarity with pediatric cervical spine anatomy, failure to recognize normal variants seen during growth and development, and suboptimal conventional film techniques.