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Management of fractured cervical vertebra (04HDC01638)
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(04HDC01638, 29 June 2005)
Public hospital ~ Emergency department ~ Radiologist ~ Neck
trauma ~ Cervical fracture ~ Examination ~ Investigation ~ X-ray ~
Diagnosis ~ Interpreting results ~ Standard of care
The mother of a 13-year-old girl complained about the standard
of care provided to her daughter by a hospital and one of its
radiologists when they failed to diagnose a neck fracture on three
separate occasions. The complaint was not upheld.
The girl fell from a tree, hurting her head and neck and losing
consciousness for about three minutes. She was taken by ambulance
to the emergency department of the local hospital. At the hospital
she was examined, had X-rays taken, and was kept under observation
for the concussion. When the X-rays appeared normal and the pain
had eased, the girl was discharged with advice to come back if the
The girl was readmitted eight to nine hours after discharge,
having collapsed and lost consciousness for two minutes. The
emergency department staff reviewed the diagnosis by re-examining
the previous day's X-rays. They upheld the diagnosis of a soft
tissue injury to the neck, and gave the girl a semi-rigid neck
collar and arranged a follow-up visit to the orthopaedic clinic.
That same day, a radiologist at the hospital reviewed the previous
night's X-rays and found no evidence of fracture.
A week later the girl returned to the emergency department for a
third time, as she was experiencing increasing neck pain. The
attending doctor arranged for more extensive X-rays to be taken.
The doctor and her senior colleague could not see a fracture on
these X-rays, and so, on the clinical evidence available, concurred
with the diagnosis of a soft tissue injury. They told the girl to
visit her general practitioner within the next week and confirmed
the outpatient appointment.
The following day, a radiologist at the hospital reviewed the
new X-rays and detected a fracture. The result was reported
immediately, the girl recalled to the hospital, and treatment
It was held that as there were no convincing fracture lines
discernable in the first set of X-rays, the radiologist did not
breach the Code by providing inadequate care. Further, the
identification of the fracture by the other radiologist from the
second set of scans was an excellent diagnosis and one many
radiologists would have overlooked.
It was also held that the public hospital did not breach the
Code. Staff investigated thoroughly, remained open in revisiting
the initial diagnosis on subsequent presentations, and followed
protocols on possible cervical spine injuries.