Clinical Identifiers for Detecting Underlying Closed Cervical Fractures

Background Although uncommon, closed cervical fractures ( CCFs ) may present in orthopedic clinical settings despite previous workup. The objective of this study was to describe the characteristics associated with missed CCF . Methods The study was a retrospective database exploration of a cohort of subjects within a department of surgery with cervical pain. The sample consisted of 162 patients seen for a surgical consult for a number of cervical conditions. The examination time frame represented a clinical examination and imaging confirmation of diagnosis after an original initial visit by another provider. Descriptive and diagnostic accuracy values including sensitivity/specificity and positive/negative likelihood ratios ( LR +/ LR −) were calculated for each targeted variable. Clustered analyses were calculated using the patient history and situational characteristics. Results Eleven patients in the sample were diagnosed with CCF (6.7%). Six variables were significantly associated with a missed CCF . Using these six variables, it was found that failure to exhibit a condition of 2 of the 6 variables (1 or fewer) was the strongest in ruling out the condition ( LR − = 0.0; post‐test probability with a negative finding = 0%), whereas a finding of 4 of 6 was the most diagnostic for ruling in the condition ( LR + = 32; post‐test probability with a positive finding = 70%). Conclusions The findings in this sample suggest that select patient history or situational factors are still useful even after initial examination and clinicians must stay vigilant because CCF s may be missed during emergent care screens.