Evaluation of low-cost computer monitors for the detection of cervical spine injuries in the emergency room: an observer confidence-based study.
BACKGROUND
To compare the diagnostic value of low-cost computer monitors and a Picture Archiving and Communication System (PACS) workstation for the evaluation of cervical spine fractures in the emergency room.


METHODS
Two groups of readers blinded to the diagnoses (2 radiologists and 3 orthopaedic surgeons) independently assessed-digital radiographs of the cervical spine (anterior-posterior, oblique and trans-oral-dens views). The radiographs of 57 patients who arrived consecutively to the emergency room in 2004 with clinical suspicion of a cervical spine injury were evaluated. The diagnostic values of these radiographs were scored on a 3-point scale (1 = diagnosis not possible/bad image quality, 2 = diagnosis uncertain, 3 = clear diagnosis of fracture or no fracture) on a PACS workstation and on two different liquid crystal display (LCD) personal computer monitors. The images were randomised to avoid memory effects. We used logistic mixed-effects models to determine the possible effects of monitor type on the evaluation of x ray images. To determine the overall effects of monitor type, this variable was used as a fixed effect, and the image number and reader group (radiologist or orthopaedic surgeon) were used as random effects on display quality. Group-specific effects were examined, with the reader group and additional fixed effects as terms. A significance level of 0.05 was established for assessing the contribution of each fixed effect to the model.


RESULTS
Overall, the diagnostic score did not differ significantly between standard personal computer monitors and the PACS workstation (both p values were 0.78).


CONCLUSIONS
Low-cost LCD personal computer monitors may be useful in establishing a diagnosis of cervical spine fractures in the emergency room.
Brem
M H
MH
Department of Surgery, Division of Trauma Surgery and Orthopaedic Surgery, Friedrich-Alexander University Erlangen-Nuremberg, Krankenhausstr 12, 91054 Erlangen, Germany. brem@bwh.harvard.edu
Böhner
C
C
Brenning
A
A
Gelse
K
K
Radkow
T
T
Blanke
M
M
Schlechtweg
P M
PM
Neumann
G
G
Wu
I Y
IY
Bautz
W
W
Hennig
F F
FF
Richter
H
H
D001291:Attitude of Health Personnel; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D016288:Computer Terminals / Q000191:economics*; D003365:Costs and Cost Analysis; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000191:economics*; D006801:Humans; D016015:Logistic Models; D008838:Microcomputers; D016017:Odds Ratio; D009985:Orthopedics; D011859:Radiography; D011871:Radiology; D013124:Spinal Injuries / Q000000981:diagnostic imaging*