A critical appraisal of clinical practice guidelines for diagnostic imaging in the spinal cord injury

Bin Guan; Guoyu Li; Ruiyuan Zheng; Yuxuan Fan; Liang Yao; Lingxiao Chen; Shiqing Feng; Hengxing Zhou

doi:10.1016/j.spinee.2023.03.003

A critical appraisal of clinical practice guidelines for diagnostic imaging in the spinal cord injury

Spine J. 2023 Aug;23(8):1189-1198. doi: 10.1016/j.spinee.2023.03.003. Epub 2023 Mar 18.

Authors

Bin Guan¹, Guoyu Li¹, Ruiyuan Zheng¹, Yuxuan Fan², Liang Yao³, Lingxiao Chen⁴, Shiqing Feng⁵, Hengxing Zhou⁶

Affiliations

¹ Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
² Department of Orthopaedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, 300052, P.R. China.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.
⁴ Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China; Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, University of Sydney, Sydney, Australia. Electronic address: lche4036@uni.sydney.edu.au.
⁵ Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China; Department of Orthopaedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, 300052, P.R. China. Electronic address: shiqingfeng@sdu.edu.cn.
⁶ Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China; Department of Orthopaedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, 300052, P.R. China. Electronic address: zhouhengxing@sdu.edu.cn.

PMID: 36934792
DOI: 10.1016/j.spinee.2023.03.003

Abstract

Background context: Spinal cord injury (SCI) is a serious health problem which carries a heavy economic burden. Imaging technologies play an important role in the diagnosis of SCI. Although several organizations have developed guidelines for diagnostic imaging of SCI, their quality has not yet been systematically assessed.

Purpose: We aim to conduct a systematic review to appraise SCI guidelines and summarize their recommendations for diagnostic imaging of SCI.

Study design: Systematic review.

Methods: We searched Embase, Medline, Web of Science, Cochrane, some guideline-specific databases (eg, Scottish Intercollegiate Guidelines Network) and Google Scholar from January 2000 to January 2022. We included guidelines developed by nationally recognized organizations. If multiple versions could be obtained, we included the latest one. We appraised included guidelines using the Appraisal of Guidelines for Research and Evaluation, 2nd edition instrument which contains six domains (eg, scope and purpose). We also extracted recommendations and assessed their supporting evidence using levels of evidence (LOE). The evidence was categorized as A (the best quality), B, C, and D (the worst quality).

Results: Seven guidelines (2008-2020) were included. They all received the lowest scores in the domain of applicability. All guidelines (7/7, 100%) recommended magnetic resonance imaging (MRI) in patients with SCI or SCI without radiographic abnormality (SCIWORA). A total of 12 recommendations involving patient age (eg, adult and child patients), timing of MRI (eg, as soon as possible and in the acute period), symptoms indicated for MRI (eg, a stiff spine and midline tenderness, suspected disc and posterior ligamentous complex injury, and neurological deficit), and types of MRI (eg, T2-weighted imaging and diffusion tensor imaging) were extracted. Among them, the LOE was C in nine (75%) recommendations and D in three (25%) recommendations.

Conclusions: Seven guidelines were included in the present systematic review, and all of them showed the worst applicability scores in the Appraisal of Guidelines for Research and Evaluation, 2nd edition instrument. They all weakly recommended MRI for patients with suspected SCI or SCIWORA based on a low LOE.

Keywords: AGREE II; Clinical practice guidelines; Diagnostic imaging; Level of evidence; MRI; Spinal cord injury.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adult
Child
Diffusion Tensor Imaging*
Humans
Magnetic Resonance Imaging
Spinal Cord Injuries* / diagnostic imaging