title: Missed or Delayed Cervical Spine or Spinal Cord Injuries Treated at a Tertiary Referral Hospital in Rwanda.
abstract: OBJECTIVE
  This study was aimed at 1) reporting cases of missed cervical spine injuries treated at a tertiary-level hospital, King Faisal Hospital, Rwanda (KFH-R), and 2) identifying the causes of delaying the diagnosis.
  
  
  METHODS
  We prospectively collected data from patients with a missed or delayed cervical spine and/or cord injury treated at King Faisal Hospital, Kigali for a 12-month period (January 2012 to December 2012). The total number of cervical spine injury patients treated at our center was retrieved from the hospital admission registry.
  
  
  RESULTS
  Forty-two patients with cervical spine or spinal cord injuries were treated at KFH-R in 2012, and 4 of them had a missed or delayed diagnosis. Clinical and radiologic findings of all 4 patients are presented, and the reasons for delaying diagnosis are identified.
  
  
  CONCLUSIONS
  This study found that the cervical spine injuries were missed in 9.5% of the cervical spine trauma patients and resulted in a longer hospital stay for all 4 patients and severe disability in 1 patient (25%). The reasons for missed diagnoses in this study were 1) lack of cervical spine radiographic evaluation, 2) inadequate cervical spine radiographs to show the level of injury, 3) poor sensitivity of cervical spine plain radiography, 4) poor physical examination, 5) the presence of a distracting injury, and 6) poor sensitivity of radiographs and computed tomography scans for soft tissue injuries.
authors.affiliation: Rwanda Neurosurgical Centre, King Faisal Hospital, Kigali, Rwanda; Directorate of Perioperative Services, King Faisal Hospital, Kigali, Rwanda; Neurosurgery Training Program, Department of Surgery, University of Rwanda, Kigali, Rwanda.
authors.forename: Agabe Emmy
authors.initials: AE
authors.lastname: Nkusi
authors.affiliation: Rwanda Neurosurgical Centre, King Faisal Hospital, Kigali, Rwanda; Neurosurgery Training Program, Department of Surgery, University of Rwanda, Kigali, Rwanda; Neurosurgery Unit, Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda.
authors.forename: Sévérien
authors.initials: S
authors.lastname: Muneza
authors.affiliation: Neurosurgery Training Program, Department of Surgery, University of Rwanda, Kigali, Rwanda. Electronic address: semaragde@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Hakizimana
authors.affiliation: Neurosurgery Training Program, Department of Surgery, University of Rwanda, Kigali, Rwanda.
authors.forename: Steven
authors.initials: S
authors.lastname: Nshuti
authors.affiliation: Neurosurgery Training Program, Department of Surgery, University of Rwanda, Kigali, Rwanda.
authors.forename: Paulin
authors.initials: P
authors.lastname: Munyemana
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000150:complications; D008297:Male; D008875:Middle Aged; D009049:Motorcycles; D019547:Neck Pain / Q000209:etiology; D011446:Prospective Studies; D012432:Rwanda / Q000453:epidemiology; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000628:therapy*; D013124:Spinal Injuries / Q000175:diagnosis / Q000628:therapy*; D013131:Spine / Q000000981:diagnostic imaging; D062606:Tertiary Care Centers; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cervical spine; Delayed; Missed; Rwanda; Spinal cord injury; Spine injury