title: Effectiveness of second-opinion radiology consultations to reassess the cervical spine CT scans: a study on trauma patients referred to a tertiary-care hospital.
abstract: OBJECTIVE
  A second opinion is a valuable resource in confirming proper medical diagnosis and treatment. This study evaluates the effectiveness of second-opinion radiology consultations to reassess the cervical spine computed tomography (CT) scans of the trauma patients referred to our hospital.
  
  
  METHODS
  Cervical spine CT scans of 301 consecutive adult trauma patients, who were referred to our hospital from outside institutions, were analyzed. The emergency radiologists at our institution completed the over-read reports on the CT images obtained at the outside facilities. A single radiologist compared the outside- and over-read reports and determined the discrepancy of the radiologic reports.
  
  
  RESULTS
  Based on the outside reports, 31% of the CT scans had cervical traumatic injury. In 92% of patients, the first-read and the over-read reports had consistent radiologic findings. About 90% of the positive, and 93% of the negative radiologic findings, were reported consistently in the over-read reports. Our analysis showed that the over-read reporting resulted in reassurance of negative findings in 63%; confirmation of positive findings in 29%; clearing a false diagnosis in 3%; and detection of a missed diagnosis in 5%. A rescan was done in 80% of patients with inconsistent and 20% of patients with consistent findings (P < 0.05). The most common missed radiologic findings in the first-reports were transverse and spinous process fractures and the most common misdiagnoses were dens fractures.
  
  
  CONCLUSIONS
  For a service offering second-opinion consultations on cervical spine trauma, review of outside CT studies improves diagnosis and benefits patient care.
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. gchoy@partners.org.
authors.forename: Omid
authors.initials: O
authors.lastname: Khalilzadeh
authors.forename: Maryam
authors.initials: M
authors.lastname: Rahimian
authors.forename: Vinay
authors.initials: V
authors.lastname: Batchu
authors.forename: Harshna V
authors.initials: HV
authors.lastname: Vadvala
authors.forename: Robert A
authors.initials: RA
authors.lastname: Novelline
authors.forename: Garry
authors.initials: G
authors.lastname: Choy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D003951:Diagnostic Errors; D006801:Humans; D008875:Middle Aged; D012017:Referral and Consultation; D015203:Reproducibility of Results; D016103:Spinal Fractures / Q000175:diagnosis*; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult