Gregory P Lekovic1, Timothy R Harrington. 1. Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Abstract
BACKGROUND: Approximately 800,000 cervical spines are cleared in emergency departments each year. Errors in diagnosis of cervical spine injury are a potentially huge medicolegal liability, but no established protocol for clearance of the cervical spine is known to reduce errors or delays in diagnosis. METHODS: The Lexis-Nexis, Westlaw, and Medline databases were queried for cases of missed cervical injury. Errors were categorized according to a novel system of classification. Type I errors occurred when inadequate or improper tests were ordered. Type II errors occurred when adequate tests were ordered, but were either misread or not read. Type III errors occurred when adequate tests were ordered and read accurately, but the ordered test was not sensitive enough to detect the injury. RESULTS: Twenty cases of missed or delayed diagnosis of cervical spine injury were found in 10 jurisdictions. Awards averaged 2.9 million dollars (inflation adjusted to 2002 dollars). Eight cases resulted in verdicts in favor of the defendant, but none of these cases involved an alleged Type II error. CONCLUSION: Fear of lawsuits encourages defensive medicine and complicates the process of clearing a patient's cervical spine. This analysis adds medicolegal support for the judicious use of imaging studies in current cervical spine clearance protocols. However, exposure to significant liability suggests that a low threshold for computed tomography is a reasonable alternative.
BACKGROUND: Approximately 800,000 cervical spines are cleared in emergency departments each year. Errors in diagnosis of cervical spine injury are a potentially huge medicolegal liability, but no established protocol for clearance of the cervical spine is known to reduce errors or delays in diagnosis. METHODS: The Lexis-Nexis, Westlaw, and Medline databases were queried for cases of missed cervical injury. Errors were categorized according to a novel system of classification. Type I errors occurred when inadequate or improper tests were ordered. Type II errors occurred when adequate tests were ordered, but were either misread or not read. Type III errors occurred when adequate tests were ordered and read accurately, but the ordered test was not sensitive enough to detect the injury. RESULTS: Twenty cases of missed or delayed diagnosis of cervical spine injury were found in 10 jurisdictions. Awards averaged 2.9 million dollars (inflation adjusted to 2002 dollars). Eight cases resulted in verdicts in favor of the defendant, but none of these cases involved an alleged Type II error. CONCLUSION: Fear of lawsuits encourages defensive medicine and complicates the process of clearing a patient's cervical spine. This analysis adds medicolegal support for the judicious use of imaging studies in current cervical spine clearance protocols. However, exposure to significant liability suggests that a low threshold for computed tomography is a reasonable alternative.
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