Most Missed SIM Case
SpCA0028-Most Missed SIM Case
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SpCA0028-Most Missed SIM Case
Case InfoHistory
26-year-old female in the emergency room with acute/subacute onset of bilateral lower extremity weakness, evaluate for cauda equina syndrome.
Exam
MR LUMBAR SPINE WO/W/IVCON.
Prior Study
None.
Answer
The Education Gap
Adhesive Arachnoiditis
FINDINGS
The lumbar vertebral column is normally aligned and there is no pathologic marrow signal intensity or fracture. Intervertebral disc space height and signal intensity is normal and the endplates are intact.
The conus medullaris terminates normally at lower L1.
On the T2 weighted sequences there is possible thickening and definite clumping of the nerve roots of the cauda equina within the thecal sac. No extradural abnormalities are noted. There is no compression of the thecal sac or nerve root sheaths at any level.
Post-contrast imaging shows diffuse enhancement within the thecal sac from the conus medullaris distally without definite focal or nodular enhancement. The abnormal enhancement includes the nerve roots and nerve root sheaths from L3/4 distally on both sides.
IMPRESSION
Findings are diagnostic of arachnoiditis and radiculitis. Infectious or otherwise inflammatory etiologies must be identified acutely. Inflammatory etiologies can include those that are immune mediated with a propensity for rapid proximal progression as well as infectious.
The study explains symptoms of cauda equine syndrome and excludes a compressive etiology.
The results were called to the referring physician at the time of dictation.
ACUITY
Urgent
STATISTICAL ANALYSIS OF SIM RESULTS
351 residents interpreted this case of cauda equina syndrome as one of 65 cases during an 8-hour simulated on-call shift, with a median score of 2 out of 10 and an overall average score of 2.26 out of 10.
On average, 7.22 points out of 10 were lost due to missed observations. At the same time, 0.38 points were lost due to interpretive errors.
We define an effective report to be one which achieves scores between 7 and 10. In terms of letter grades, this would be A & B. In this “most missed” case 11% of residents produced effective reports.
We define a report having a critical error to be one with scores between 0 and 2. In terms of letter grades, this would be F & D. In this “most missed” case 84% of residents produced reports with critical error(s).
The lumbar vertebral column is normally aligned and there is no pathologic marrow signal intensity or fracture. Intervertebral disc space height and signal intensity is normal and the endplates are intact.
The conus medullaris terminates normally at lower L1.
On the T2 weighted sequences there is possible thickening and definite clumping of the nerve roots of the cauda equina within the thecal sac. No extradural abnormalities are noted. There is no compression of the thecal sac or nerve root sheaths at any level.
Post-contrast imaging shows diffuse enhancement within the thecal sac from the conus medullaris distally without definite focal or nodular enhancement. The abnormal enhancement includes the nerve roots and nerve root sheaths from L3/4 distally on both sides.
IMPRESSION
Findings are diagnostic of arachnoiditis and radiculitis. Infectious or otherwise inflammatory etiologies must be identified acutely. Inflammatory etiologies can include those that are immune mediated with a propensity for rapid proximal progression as well as infectious.
The study explains symptoms of cauda equine syndrome and excludes a compressive etiology.
The results were called to the referring physician at the time of dictation.
ACUITY
Urgent
STATISTICAL ANALYSIS OF SIM RESULTS
351 residents interpreted this case of cauda equina syndrome as one of 65 cases during an 8-hour simulated on-call shift, with a median score of 2 out of 10 and an overall average score of 2.26 out of 10.
On average, 7.22 points out of 10 were lost due to missed observations. At the same time, 0.38 points were lost due to interpretive errors.
We define an effective report to be one which achieves scores between 7 and 10. In terms of letter grades, this would be A & B. In this “most missed” case 11% of residents produced effective reports.
We define a report having a critical error to be one with scores between 0 and 2. In terms of letter grades, this would be F & D. In this “most missed” case 84% of residents produced reports with critical error(s).
