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.
Spine J. 2023 Aug;23(8):1189-1198. doi: 10.1016/j.spinee.2023.03.003. Epub 2023 Mar 18.
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.
We aim to conduct a systematic review to appraise SCI guidelines and summarize their recommendations for diagnostic imaging of SCI.
Systematic review.
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).
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.
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.
脊髓损伤（SCI）是一个严重的健康问题，给经济带来了沉重的负担。成像技术在 SCI 的诊断中起着重要作用。尽管一些组织已经制定了 SCI 诊断成像指南，但它们的质量尚未得到系统评估。
我们旨在进行系统评价，以评估 SCI 指南，并总结其对 SCI 诊断成像的建议。
系统评价。
我们从 2000 年 1 月至 2022 年 1 月在 Embase、Medline、Web of Science、Cochrane、一些指南特定的数据库（如苏格兰校际指南网络）和 Google Scholar 中进行了搜索。我们纳入了由具有国家认可的组织制定的指南。如果能获得多个版本，则纳入最新的版本。我们使用评估研究和评估指南，第二版工具（包含六个领域，如范围和目的）评估纳入的指南。我们还提取了建议，并使用证据水平（LOE）评估其支持证据。证据分为 A（最佳质量）、B、C 和 D（最差质量）。
纳入了 7 项指南（2008-2020 年）。它们在适用性领域的得分都最低。所有指南（7/7，100%）都建议对 SCI 或 SCI 无放射学异常（SCIWORA）患者进行磁共振成像（MRI）检查。总共提取了 12 项涉及患者年龄（如成人和儿童患者）、MRI 时间（如尽快和急性期）、MRI 指征（如僵硬的脊柱和中线压痛、疑似椎间盘和后韧带复合体损伤以及神经功能缺损）和 MRI 类型（如 T2 加权成像和弥散张量成像）的建议。其中，9 项（75%）建议的 LOE 为 C，3 项（25%）建议的 LOE 为 D。
本系统评价纳入了 7 项指南，它们在评估研究和评估指南，第二版工具中的适用性得分均最差。它们都基于低 LOE，对疑似 SCI 或 SCIWORA 患者的 MRI 检查提出了弱建议。
