Tay Yi Xiang, Foley Shane J, Ong Marcus Eh, Chen Robert Chun, Chan Lai Peng, Killeen Ronan, Tan Eu Jin, Mak May San, McNulty Jonathan P
Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland; Radiography Department, Allied Health Division, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
Eur J Radiol. 2025 Feb;183:111933. doi: 10.1016/j.ejrad.2025.111933. Epub 2025 Jan 18.
Countries worldwide have selected, adopted, adapted, and translated evidence-based imaging referral guidelines from radiology professional bodies. This study establishes the concordance of three imaging referral guidelines from the ACR, ESR, and RCR, and examines the emergency department cervical spine imaging appropriateness rates.
A retrospective analysis of the electronic medical records was performed between October 1st to December 31st, 2022, evaluating 452 radiography and 153 CT imaging referrals. For each case, the initial clinical diagnosis was integrated with the corresponding clinical notes for analysis. Evaluation of the appropriateness rating was dichotomised to either 'indicated' or 'not indicated' for analytical and practical purposes. The inter-rater agreement for the imaging referral guidelines was calculated using Fleiss' Kappa and Cohen's Kappa.
The overall appropriateness rate of X-ray cervical spine imaging referrals was 13.3 % -75.2 %, depending on the imaging referral guidelines utilised. The appropriateness rate of CT cervical spine was 90.8 %, which was an identical rate for all three of the guidelines. Fleiss' Kappa indicated the guidelines for X-ray of the cervical spine had slight agreement (κ = 0.135 (95 % CI, 0.088 to 0.183), p < 0.001) and almost perfect agreement amongst guidelines for CT cervical spine (κ = 1.000 (95 % CI, 0.909 to 1.091), p < 0.001). For pairwise comparison, ACR AC and ESR iGuide for X-ray demonstrated moderate agreement (κ = 0.765, p < 0.001); however, RCR iRefer had no level of agreement with both. For CT, there was almost perfect agreement between all the guidelines.
The guidelines demonstrated slight agreement for X-ray cervical spine and almost perfect agreement for CT cervical spine, complicating audit process and influencing audit output. Multidisciplinary buy-in positively impacts CT cervical spine appropriateness rates. Harmonising and prioritising guideline development for commonly encountered clinical scenarios is required.
世界各国已选择、采用、调整并翻译了放射学专业机构基于证据的影像转诊指南。本研究确定了美国放射学会（ACR）、欧洲放射学会（ESR）和英国皇家放射学院（RCR）的三项影像转诊指南的一致性，并检查了急诊科颈椎影像检查的适宜率。
对2022年10月1日至12月31日期间的电子病历进行回顾性分析，评估452例X线摄影和153例CT影像转诊。对于每个病例，将初始临床诊断与相应的临床记录相结合进行分析。为了分析和实际应用的目的，将适宜性评级评估分为“有指征”或“无指征”。使用Fleiss卡方和Cohen卡方计算影像转诊指南的评分者间一致性。
根据所采用的影像转诊指南，颈椎X线影像转诊的总体适宜率为13.3%至75.2%。颈椎CT的适宜率为90.8%，这在所有三项指南中是相同的。Fleiss卡方表明，颈椎X线指南的一致性较低（κ = 0.135（95%置信区间，0.088至0.183），p < 0.001），而颈椎CT指南之间几乎完全一致（κ = 1.000（95%置信区间，0.909至1.091），p < 0.001）。进行两两比较时，ACR的AC和ESR的iGuide在X线方面显示出中度一致性（κ = 0.765，p < 0.001）；然而，RCR的iRefer与两者均无一致性。对于CT，所有指南之间几乎完全一致。
这些指南在颈椎X线方面显示出较低的一致性，而在颈椎CT方面几乎完全一致，这使审核过程复杂化并影响审核结果。多学科的支持对颈椎CT适宜率有积极影响。需要协调并优先制定常见临床情况的指南。
