Evaluating the Impact of a Standardised CT Reporting Checklist on Missed Cervical Spine Injury Detection in a Major African Trauma Centre: A Comparative Study, 2016

Missed cervical spine injuries in major trauma patients can lead to catastrophic neurological outcomes. In busy African trauma centres, the interpretation of complex cervical spine computed tomography (CT) scans is prone to error, particularly without a structured reporting tool. This study aimed to quantify the impact of introducing a standardised CT reporting checklist on the rate of missed cervical spine injuries in a major African trauma centre. A retrospective comparative study was conducted at the Trauma Centre, Inkosi Albert Luthuli Central Hospital. Two cohorts of consecutive major trauma patients who underwent cervical spine CT were compared: a pre-intervention group (reports without checklist) and a post-intervention group (reports using a standardised checklist). Missed injuries were identified via a review of all subsequent imaging, clinical notes, and multidisciplinary meeting records. The implementation of the checklist was associated with a statistically significant reduction in the missed injury rate. The proportion of patients with a missed cervical spine injury fell from 8.2% in the pre-intervention cohort to 2.1% in the post-intervention cohort. The introduction of a standardised CT reporting checklist significantly reduced the rate of missed cervical spine injuries in this setting. The adoption of a standardised reporting checklist for cervical spine CT in major trauma should be considered by similar institutions across Africa to improve detection rates. Further research should assess its impact on inter-observer variability and clinical outcomes. Cervical vertebrae, Spinal injuries, Tomography (X-ray computed), Checklist, Diagnostic errors, Trauma centres, Africa. This study provides original, quantitative evidence from a major African trauma centre supporting the use of a structured reporting tool to enhance radiological detection of clinically significant injuries.