Missed and mismanaged injuries of the spinal cord

OBJECTIVE: The purpose of this study was to determine the incidence of missed and mismanaged injuries of the spinal cord, to identify factors contributing to a failure to recognize such injuries, and to assess the consequences of such failures. METHODS: Missed and mismanaged injuries were defined using previously validated statements. All medical records and radiographs of patients with acute traumatic spinal cord injury admitted to the Regional Spinal Cord Injury Unit in Sheffield, United Kingdom, over a period of 10 years from 1989 were evaluated. Patients with no neurologic deficits were excluded from the study. RESULTS: Of the 569 patients, the diagnosis of spinal cord injury was missed in 52 instances (9.1%). The patients were mismanaged in 34 instances, and the treatment offered to 30 was considered negligent. In 26 of 52 (50%), mismanagement resulted in neurologic deterioration. The study identified several factors that contributed to a failure to recognize a spinal cord injury. These include ambience and circumstances surrounding the injury, inadequate neurologic assessment, associated injuries, and radiographic errors. CONCLUSION: Despite a greater awareness of the potential for spinal injury after road traffic accidents, failure to recognize a spinal cord injury in the acute care setting appears to be increasing. Injuries are seldom missed because of an isolated cause, but rather because of a combination of several factors. Increased vigilance on the part of the primary care physicians and careful documentation may reduce allegations of medical negligence.