Preventable diagnostic errors in fatal cervical spine injuries: a nationwide register-based study from 1987 to 2010

Publication date: Available online 16 August 2017
Source:The Spine Journal
Author(s): Tuomo Thesleff, Tero Niskakangas, Teemu Luoto, Grant L Iverson, Juha Öhman, Antti Ronkainen
BackgroundFall-induced injuries in patients are increasing in number and they often lead to serious consequences, such as cervical spine injuries (CSI). CSI diagnostics remain a challenge despite improved radiological services.PurposeOur aim is to define the incidence and risk factors for diagnostic errors among patients who died following a CSI.Study Design/SettingRetrospective death certificate-based study of the whole population of XXX.Patient sampleWe identified 2,041 patients whose death was, according to the death certificate, either directly or indirectly caused by a CSI.Outcome measuresDemographics, injury- and death-related data, and adverse event-related data.MethodsAll death certificates between the years 1987 and 2010 from Statistics XXX that identified a CSI as a cause death were reviewed to identify preventable adverse events (PAE) with the emphasis on diagnostic errors.ResultsOf the 2,041 patients with CSI-related deaths, 36.5% (n=744) survived at least until the next day. Errors in CSI diagnostics were found in 13.8% (n=103) of those who died later than the day of injury. Those with diagnostic errors were significantly older (median age 79.4 years, 95% CI 75.9-80.1 vs. 74.9, 95% CI 70.2-72.9, p<0.001) and the mechanism of injury was significantly more often a fall (86.4%, n=89 vs. 69.7%, n=447, p=0.002) compared to those who did not have a diagnostic error. The incidence of diagnostic errors increased slightly during the 24–year study period.ConclusionsCervical spine injury diagnostics remain difficult despite improved radiological services. The majority of the patients subjected to diagnostic errors are fragile elderly people with reduced physical capacity. In our analysis, preventable adverse events and diagnostic errors were most commonly associated with ground-level falls.



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