ArticleBMJ open quality2020
Appropriate CT cervical spine utilisation in the emergency department.
Article in BMJ open quality, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 12 citations in OpenAlex.
- Effectiveness of implementation strategies for increasing clinicians' use of five validated imaging decision rules for musculoskeletal injuries: a systematic review.BMC emergency medicine · 2024Pooled it
- Interventions to reduce low-value imaging - a systematic review of interventions and outcomes.BMC health services research · 2021Pooled it
- Concurrent emergency head and cervical spine CT utilization: temporal trends, diagnostic yield, and clinical implications.Emergency radiology · 2026Article
- A Quality Improvement Campaign Reduces Head and Cervical Spine Imaging in Low-risk Trauma Patients.The western journal of emergency medicine · 2026Article
- External validation of the REDUCTION clinical decision aids for ruling out fractures in patients with midfacial and mandibular injuries in the emergency department: a protocol for a prospective multi-centre cohort study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review.BMJ open · 2023Article
- Measuring appropriateness of diagnostic imaging: a scoping review.Insights into imaging · 2023Article
- Diagnostic accuracy of deep learning for evaluation of C-spine injury from lateral neck radiographs.Heliyon · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionOver 40 000 CT scans are performed in our emergency department (ED) annually and utilisation is over 80% capacity. Improving medical appropriateness of CT scans may reduce total number of scans, time, cost and radiation exposure.
methodsLean Six Sigma methodology was used to improve the process. A National Emergency X-Radiography Utilisation Study (NEXUS)-based PowerForm was implemented in the electronic health record and providers were educated on the criteria.
resultsThe rate of potentially medically inappropriate CT C-spine scans decreased from 45% (19/42) to 22% (90/403) (two-proportion test, p=0.002). After the intervention, there was no longer a difference between midlevel providers and physicians in the rate of medically inappropriate orders (19% vs 22%) (two-proportion test, p=0.850) compared with that before the intervention (56% vs 31%) (two-proportion test, p<0.01). Overall rates of CT C-spine scans ordered decreased from 69.3 to 62.6/week (t-test, p=0.019).
conclusionA validated clinical decision-making tool implemented into the medical record can improve quality of care. This study lays a foundation for other imaging studies with validated support tools with similar potential improvements.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.