Awareness and use of five imaging decision rules for musculoskeletal injuries: a systematic review

Awareness and use of five imaging decision rules for musculoskeletal injuries: a systematic review

Canadian C-Spine Rule, Canadian CT Head Rule, NEXUS guidelines, Ottawa Ankle Rules, Ottawa Knee
Rules

Background Several validated decision rules are available for clinicians to guide the appropriate use of imaging
for patients with musculoskeletal injuries, including the Canadian CT Head Rule, Canadian C-Spine Rule, National
Emergency X-Radiography Utilization Study (NEXUS) guideline, Ottawa Ankle Rules and Ottawa Knee Rules. However,
it is unclear to what extent clinicians are aware of the rules and are using these five rules in practice.
Objective To determine the proportion of clinicians that are aware of five imaging decision rules and the proportion
that use them in practice.
Design Systematic review.
Methods This was a systematic review conducted in accordance with the ‘Preferred reporting items for systematic
reviews and meta-analyses’ (PRISMA) statement. We performed searches in MEDLINE (via Ovid), CINAHL (via EBSCO),
EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Scopus databases
to identify observational and experimental studies with data on the following outcomes among clinicians related

to five validated imaging decision rules: awareness, use, attitudes, knowledge, and barriers and facilitators to imple-
mentation. Where possible, we pooled data using medians to summarise these outcomes.

Results We included 39 studies. Studies were conducted in 15 countries (e.g. the USA, Canada, the UK, Australasia,

New Zealand) and included various clinician types (e.g. emergency physicians, emergency nurses and nurse practi-
tioners). Among the five decision rules, clinicians’ awareness was highest for the Canadian C-Spine Rule (84%, n=3

studies) and lowest for the Ottawa Knee Rules (18%, n=2). Clinicians’ use was highest for NEXUS (median percentage
ranging from 7 to 77%, n=4) followed by Canadian C-Spine Rule (56–71%, n=7 studies) and lowest for the Ottawa
Knee Rules which ranged from 18 to 58% (n=4).

Conclusion Our results suggest that awareness of the five imaging decision rules is low. Changing clinicians’ atti-
tudes and knowledge towards these decision rules and addressing barriers to their implementation could increase

use.
Keywords Canadian C-Spine Rule, Canadian CT Head Rule, NEXUS guidelines, Ottawa Ankle Rules, Ottawa Knee
Rules

Priti Kharel1*, Joshua R. Zadro1

, Zhang Chen2

, Madii A. Himbury2

, Adrian C. Traeger1

, James Linklater3 and

Christopher G. Maher1

https://doi.org/10.1186/s12245-023-00555-4

2023

peri irawan

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