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

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 (e.g., 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 AGREE II instrument which contains six domains (e.g., 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 to 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 (e.g., adult and child patients), timing of MRI (e.g., as soon as possible and in the acute period), symptoms indicated for MRI (e.g., a stiff spine and midline tenderness, suspected disc and posterior ligamentous complex injury, and neurological deficit), and types of MRI (e.g., 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 AGREE II instrument. They all weakly recommended MRI for patients with suspected SCI or SCIWORA based on a low LOE.