Effectiveness of second-opinion radiology consultations to reassess the cervical spine CT scans: a study on trauma patients referred to a tertiary-care hospital

PURPOSE

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.

CONCLUSION

For a service offering second-opinion consultations on cervical spine trauma, review of outside CT studies improves diagnosis and benefits patient care.The quality of healthcare has become a target of increasing public scrutiny and governmental concern while radiologic evaluation has assumed an increasingly important role in the diagnosis and management of patients (1). Public attention and awareness have increased and amplified the focus on the quality of healthcare (2). Some medical errors are extremely costly particularly with respect to patient morbidity and mortality.Patients referred to the tertiary care centers often arrive with radiologic imaging having already been performed at the primary institution. As part of the care to be delivered by the radiologists at the referral center, a second-opinion interpretation of the imaging studies is often requested, and the formal reports are incorporated into the patient’s permanent medical record at the referral institution where the patient’s management and treatment are determined.The added value of the point-of-care second interpretations can be viewed from the medical perspective of guiding and expediting appropriate treatment as well as from the financial perspective of avoiding unnecessary studies, at times incurring additional patient radiation exposure, when initial examinations need to be repeated or when additional examinations are suggested by the radiologist at an outside institution (3).Multidetector CT is an essential part of the assessment of patients suspected of having cervical spine injury after trauma. Despite all the advantages of multidetector CT, suspected spinal injury continues to be a daily challenge in clinical practice (4). Spine injuries are frequently missed; therefore, a second opinion can potentially improve the diagnosis (5). The purpose of this study was to evaluate the effectiveness of second-opinion radiology consultations to reassess the cervical spine CT scans of the trauma patients referred to our hospital.     

Screw-Home Movement of the Tibiofemoral Joint during Normal Gait: Three-Dimensional Analysis

Background

The purpose of this study was to evaluate the screw-home movement at the tibiofemoral joint during normal gait by utilizing the 3-dimensional motion capture technique.

Methods

Fifteen young males and fifteen young females (total 60 knee joints) who had no history of musculoskeletal disease or a particular gait problem were included in this study. Two more markers were attached to the subject in addition to the Helen-Hayes marker set. Thus, two virtual planes, femoral coronal plane (P_f) and tibial coronal plane (P_t), were created by Skeletal Builder software. This study measured the 3-dimensional knee joint movement in the sagittal, coronal, and transverse planes of these two virtual planes (P_f and P_t) during normal gait.

Results

With respect to kinematics and kinetics, both males and females showed normal adult gait patterns, and the mean difference in the temporal gait parameters was not statistically significant (p > 0.05). In the transverse plane, the screw-home movement occurred as expected during the pre-swing phase and the late-swing phase at an angle of about 17°. However, the tibia rotated externally with respect to the femur, rather than internally, while the knee joint started to flex during the loading response (paradoxical screw-home movement), and the angle was 6°.

Conclusions

Paradoxical screw-home movement may be an important mechanism that provides stability to the knee joint during the remaining stance phase. Obtaining the kinematic values of the knee joint during gait can be useful in diagnosing and treating the pathological knee joints.     

Surgical suture assembled with polymeric drug-delivery sheet for sustained,local pain relief

Surgical suture is a strand of biocompatible material designed for wound closure, and therefore can be a medical device potentially suitable for local drug delivery to treat pain at the surgical site. However, the preparation methods previously introduced for drug-delivery sutures adversely influenced the mechanical strength of the suture itself – strength that is essential for successful wound closure. Thus, it is not easy to control drug delivery with sutures, and the drug-delivery surgical sutures available for clinical use are now limited to anti-infection roles. Here, we demonstrate a surgical suture enabled to provide controlled delivery of a pain-relief drug and, more importantly, we demonstrate how it can be fabricated to maintain the mechanical strength of the suture itself. For this purpose, we separately prepare a drug-delivery sheet composed of a biocompatible polymer and a pain-relief drug, which is then physically assembled with a type of surgical suture that is already in clinical use. In this way, the drug release profiles can be tailored for the period of therapeutic need by modifying only the drug-loaded polymer sheet without adversely influencing the mechanical strength of the suture. The drug-delivery sutures in this work can effectively relieve the pain at the surgical site in a sustained manner during the period of wound healing, while showing biocompatibility and mechanical properties comparable to those of the original surgical suture in clinical use.     

A geopolymer route to micro- and meso-porous carbon

Hexagonal and wormhole-type mesoporous geopolymers were developed by controlling the concentration of a structure directing agent (cetrimonium bromide, CTAB) with fixed ratios of Si/Al, KOH/(Si + Al), and H₂O/(Si + Al), and their detailed porous structures were confirmed by TEM, N₂ adsorption–desorption and X-ray diffraction measurements. The as-prepared geopolymers were then used as templates to replicate porous carbons with various structures and porosities for CO₂ adsorption. To understand the correlation between the CO₂ adsorptivity and porous structures, we tuned the porosity of the geopolymer-templated carbons by modifying the structures of the geopolymers. The porous carbons obtained from the hexagonal-type porous geopolymers were found to be composed of the aggregates of carbon nanowires exhibiting large particles, while those obtained from the wormhole-like porous geopolymers were determined to be wormhole type as well, as evidenced by TEM and X-ray diffraction studies. According to the CO₂ adsorption isotherms of the porous carbons, the aggregates of carbon nanowires exhibited the highest CO₂ adsorptivity due to their highest microporosity and largest specific surface area.

We report the synthesis of microporous carbon through a geopolymer route starting from natural clay kaolinite.     

Exeter Short Stems Compared With Standard Length Exeter Stems : Experience From the Australian Orthopaedic Association National Joint Replacement Registry

The standard Exeter stem has a length of 150 mm with offsets 37.5 to 56 mm. Shorter stems of lengths 95, 115 and 125 mm with offsets 35.5 mm or less are available for patients with smaller femurs. Concern has been raised regarding the behavior of the smaller implants. This paper analyzed data from the Australian Orthopaedic Association National Joint Replacement Registry comparing survivorship of stems of offset 35.5 mm or less with the standard stems of 37.5 mm offset or greater. At 7 years, there was no significant difference in the cumulative percent revision rate in the short stems (3.4%, 95% CI 2.4-4.8%) compared with the standard length stems (3.5%, 95% CI 3.3-3.8%) despite its use in a greater proportion of potentially more difficult developmental dysplasia of the hip cases.