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Evaluation of low-cost computer monitors for the detection of cervical spine injuries in the emergency room: an observer confidence-based study
  1. M H Brem1,
  2. C Böhner2,
  3. A Brenning3,
  4. K Gelse1,
  5. T Radkow2,
  6. M Blanke1,
  7. P M Schlechtweg4,
  8. G Neumann4,
  9. I Y Wu4,
  10. W Bautz2,
  11. F F Hennig1,
  12. H Richter1
  1. 1Department of Surgery, Division of Trauma Surgery and Orthopaedic Surgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
  2. 2Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg
  3. 3Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg
  4. 4Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to:
 M H Brem
 Department of Surgery, Division of Trauma Surgery and Orthopaedic Surgery, Friedrich-Alexander University Erlangen-Nuremberg, Krankenhausstr 12, 91054 Erlangen, Germany; brem{at}


Background: 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.

Methods: 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.

Results: Overall, the diagnostic score did not differ significantly between standard personal computer monitors and the PACS workstation (both p values were 0.78).

Conclusion: Low-cost LCD personal computer monitors may be useful in establishing a diagnosis of cervical spine fractures in the emergency room.

  • LCD, liquid crystal display
  • PACS, Picture Archiving and Communication System

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  • Funding: None.

  • Competing interests: None.