title: 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.
  
  
  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.
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98105, USA. anthony.avellino@seattlechildrens.org
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Avellino
authors.forename: Fred A
authors.initials: FA
authors.lastname: Mann
authors.forename: M Sean
authors.initials: MS
authors.lastname: Grady
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ellenbogen
authors.forename: Tord D
authors.initials: TD
authors.lastname: Alden
authors.forename: Sohail K
authors.initials: SK
authors.lastname: Mirza
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008403:Mass Screening / Q000379:methods; D012189:Retrospective Studies; D012196:Review Literature as Topic; D016103:Spinal Fractures / Q000175:diagnosis* / Q000453:epidemiology*; D013124:Spinal Injuries / Q000175:diagnosis* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D014193:Trauma Centers