دورية أكاديمية
Effectiveness of implementation strategies for increasing clinicians’ use of five validated imaging decision rules for musculoskeletal injuries: a systematic review
| العنوان: | Effectiveness of implementation strategies for increasing clinicians’ use of five validated imaging decision rules for musculoskeletal injuries: a systematic review |
|---|---|
| المؤلفون: | Priti Kharel, Joshua R. Zadro, Grace Wong, Kittirut Rojanabenjawong, Adrian Traeger, James Linklater, Christopher G. Maher |
| المصدر: | BMC Emergency Medicine, Vol 24, Iss 1, Pp 1-20 (2024) |
| بيانات النشر: | BMC, 2024. |
| سنة النشر: | 2024 |
| المجموعة: | LCC:Special situations and conditions LCC:Medical emergencies. Critical care. Intensive care. First aid |
| مصطلحات موضوعية: | Canadian C-spine Rule, Canadian CT Head Rule, NEXUS guidelines, Ottawa Ankle Rules and Ottawa knee Rule, Special situations and conditions, RC952-1245, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9 |
| الوصف: | Abstract Background Strategies to enhance clinicians’ adherence to validated imaging decision rules and increase the appropriateness of imaging remain unclear. Objective To evaluate the effectiveness of various implementation strategies for increasing clinicians’ use of five validated imaging decision rules (Ottawa Ankle Rules, Ottawa Knee Rule, Canadian C-Spine Rule, National Emergency X-Radiography Utilization Study and Canadian Computed Tomography Head Rule). Design Systematic review. Methods The inclusion criteria were experimental, quasi-experimental study designs comprising randomised controlled trials (RCTs), non-randomised controlled trials, and single-arm trials (i.e. prospective observational studies) of implementation interventions in any care setting. The search encompassed electronic databases up to March 11, 2024, including MEDLINE (via Ovid), CINAHL (via EBSCO), EMBASE (via Ovid), Cochrane CENTRAL, Web of Science, and Scopus. Two reviewers assessed the risk of bias of studies independently using the Cochrane Effective Practice and Organization of Care Group (EPOC) risk of bias tool. The primary outcome was clinicians’ use of decision rules. Secondary outcomes included imaging use (indicated, non-indicated and overall) and knowledge of the rules. Results We included 22 studies (5-RCTs, 1-non-RCT and 16-single-arm trials), conducted in emergency care settings in six countries (USA, Canada, UK, Australia, Ireland and France). One RCT suggested that reminders may be effective at increasing clinicians’ use of Ottawa Ankle Rules but may also increase the use of ankle radiography. Two RCTs that combined multiple intervention strategies showed mixed results for ankle imaging and head CT use. One combining educational meetings and materials on Ottawa Ankle Rules reduced ankle injury imaging among ED physicians, while another, with similar efforts plus clinical practice guidelines and reminders for the Canadian CT Head Rule, increased CT imaging for head injuries. For knowledge, one RCT suggested that distributing guidelines had a limited short-term impact but improved clinicians’ long-term knowledge of the Ottawa Ankle Rules. Conclusion Interventions such as pop-up reminders, educational meetings, and posters may improve adherence to the Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian CT Head Rule. Reminders may reduce non-indicated imaging for knee and ankle injuries. The uncertain quality of evidence indicates the need for well-conducted RCTs to establish effectiveness of implementation strategies. |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 1471-227X |
| Relation: | https://doaj.org/toc/1471-227X |
| DOI: | 10.1186/s12873-024-00996-x |
| URL الوصول: | https://doaj.org/article/6388bc09dcd34eba9ffe96ccfe85cbf6 |
| رقم الأكسشن: | edsdoj.6388bc09dcd34eba9ffe96ccfe85cbf6 |
| قاعدة البيانات: | Directory of Open Access Journals |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 1471227X |
|---|---|
| DOI: | 10.1186/s12873-024-00996-x |