Brem M H, Böhner C, Brenning A, Gelse K, Radkow T, Blanke M, Schlechtweg P M, Neumann G, Wu I Y, Bautz W, Hennig F F, Richter H
Department of Surgery, Division of Trauma Surgery and Orthopaedic Surgery, Friedrich-Alexander University Erlangen-Nuremberg, Krankenhausstr 12, 91054 Erlangen, Germany.
Emerg Med J. 2006 Nov;23(11):850-3. doi: 10.1136/emj.2006.036822.
To compare the diagnostic value of low-cost computer monitors and a Picture Archiving and Communication System (PACS) workstation for the evaluation of cervical spine fractures in the emergency room.
Two groups of readers blinded to the diagnoses (2 radiologists and 3 orthopaedic surgeons) independently assessed-digital radiographs of the cervical spine (anterior-posterior, oblique and trans-oral-dens views). The radiographs of 57 patients who arrived consecutively to the emergency room in 2004 with clinical suspicion of a cervical spine injury were evaluated. The diagnostic values of these radiographs were scored on a 3-point scale (1 = diagnosis not possible/bad image quality, 2 = diagnosis uncertain, 3 = clear diagnosis of fracture or no fracture) on a PACS workstation and on two different liquid crystal display (LCD) personal computer monitors. The images were randomised to avoid memory effects. We used logistic mixed-effects models to determine the possible effects of monitor type on the evaluation of x ray images. To determine the overall effects of monitor type, this variable was used as a fixed effect, and the image number and reader group (radiologist or orthopaedic surgeon) were used as random effects on display quality. Group-specific effects were examined, with the reader group and additional fixed effects as terms. A significance level of 0.05 was established for assessing the contribution of each fixed effect to the model.
Overall, the diagnostic score did not differ significantly between standard personal computer monitors and the PACS workstation (both p values were 0.78).
Low-cost LCD personal computer monitors may be useful in establishing a diagnosis of cervical spine fractures in the emergency room.
比较低成本电脑显示器和图像存档与通信系统（PACS）工作站在急诊室评估颈椎骨折中的诊断价值。
两组对诊断不知情的读者（2名放射科医生和3名骨科医生）独立评估颈椎的数字X线片（前后位、斜位和经口齿状突位片）。对2004年连续进入急诊室且临床怀疑颈椎损伤的57例患者的X线片进行评估。这些X线片的诊断价值在PACS工作站以及两台不同的液晶显示器（LCD）个人电脑显示器上按照3分制进行评分（1 = 无法诊断/图像质量差，2 = 诊断不确定，3 = 明确诊断骨折或无骨折）。图像随机排列以避免记忆效应。我们使用逻辑混合效应模型来确定显示器类型对X线图像评估的可能影响。为确定显示器类型的总体影响，将该变量用作固定效应，将图像编号和读者组（放射科医生或骨科医生）用作显示器质量的随机效应。检查特定组的效应，将读者组和其他固定效应作为项。设定显著性水平为0.05以评估每个固定效应对模型的贡献。
总体而言，标准个人电脑显示器和PACS工作站之间的诊断评分无显著差异（p值均为0.78）。
低成本LCD个人电脑显示器在急诊室诊断颈椎骨折中可能有用。
