{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T19:59:17Z","timestamp":1774382357940,"version":"3.50.1"},"reference-count":54,"publisher":"Georg Thieme Verlag KG","issue":"01","funder":[{"name":"Kashan University of Medical Research Council","award":["96190"],"award-info":[{"award-number":["96190"]}]},{"DOI":"10.13039\/501100021698","name":"National Agency for Strategic Research in Medical Education","doi-asserted-by":"crossref","award":["970478"],"award-info":[{"award-number":["970478"]}],"id":[{"id":"10.13039\/501100021698","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003One of the best practices for timely and efficient diagnoses of central nervous system (CNS) trauma and complex diseases is imaging. However, rates of imaging for CNS are high and impose a lot of costs to health care facilities in addition to exposing patients with negative impact of ionizing radiation.<\/jats:p><jats:p>\n          Objectives\u2003This study aimed to systematically review the effects and features of clinical decision support systems (CDSSs) for the appropriate use of imaging for CNS injuries.<\/jats:p><jats:p>\n          Method\u2003We searched MEDLINE, SCOPUS, Web of Science, and Cochrane without time period restriction. We included experimental and quasiexperimental studies that assessed the effectiveness of CDSSs designed for the appropriate use of imaging for CNS injuries in any clinical setting, including primary, emergency, and specialist care. The outcomes were categorized based on imaging-related, physician-related, and patient-related groups.<\/jats:p><jats:p>\n          Result\u2003A total of 3,223 records were identified through the online literature search. Of the 55 potential papers for the full-text review, 11 eligible studies were included. Reduction of CNS imaging proportion varied from 2.6 to 40% among the included studies. Physician-related outcomes, including guideline adherence, diagnostic yield, and knowledge, were reported in five studies, and all demonstrated positive impact of CDSSs. Four studies had addressed patient-related outcomes, including missed or delayed diagnosis, as well as length of stay. These studies reported a very low rate of missed diagnosis due to the cancellation of computed tomography (CT) examine according to the CDSS recommendations.<\/jats:p><jats:p>\n          Conclusion\u2003This systematic review reports that CDSSs decrease the utilization of CNS CT scan, while increasing physicians' adherence to the rules. However, the possible harm of CDSSs to patients was not well addressed by the included studies and needs additional investigation. The actual effect of CDSSs on appropriate imaging would be realized when the saved cost of examinations is compared with the cost of missed diagnosis.<\/jats:p>","DOI":"10.1055\/s-0041-1740921","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T23:55:08Z","timestamp":1642031708000},"page":"037-052","source":"Crossref","is-referenced-by-count":9,"title":["Effectiveness of Clinical Decision Support Systems on the Appropriate Use of Imaging for Central Nervous System Injuries: A Systematic Review"],"prefix":"10.1055","volume":"13","author":[{"given":"Sahar","family":"Zare","sequence":"additional","affiliation":[{"name":"Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zohre","family":"Mobarak","sequence":"additional","affiliation":[{"name":"Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zahra","family":"Meidani","sequence":"additional","affiliation":[{"name":"Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ehsan","family":"Nabovati","sequence":"additional","affiliation":[{"name":"Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zahra","family":"Nazemi","sequence":"additional","affiliation":[{"name":"Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,1,12]]},"reference":[{"key":"ref1","volume-title":"Electronic Health Record-Based Interventions for Reducing Inappropriate Imaging in the Clinical Setting: A Systematic Review of the Evidence","author":"C L Goldzweig","year":"2015"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"121","DOI":"10.2214\/AJR.16.16110","article-title":"Impact of a collaborative radiology utilization management program: does the specialty of the referring provider matter?","volume":"207","author":"D P Friedman","year":"2016","journal-title":"Am J Roentgenol"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/S1474-4422(18)30415-0","article-title":"Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"18","author":"G BD Global","year":"2019","journal-title":"Lancet Neurol"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"73","DOI":"10.3810\/pgm.1998.11.402","article-title":"Central nervous system imaging. When is CT more appropriate than MRI?","volume":"104","author":"S Laughlin","year":"1998","journal-title":"Postgrad Med"},{"issue":"07","key":"ref5","first-page":"1","article-title":"National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary","author":"S R Pitts","year":"2008","journal-title":"Natl Health Stat Rep"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/acem.13061","article-title":"Computed tomography use for adults with head injury: describing likely avoidable emergency department imaging based on the Canadian CT head rule","volume":"24","author":"A L Sharp","year":"2017","journal-title":"Acad Emerg Med"},{"issue":"03","key":"ref7","doi-asserted-by":"publisher","DOI":"10.1145\/3301423","article-title":"Automated usability evaluation of virtual reality applications","volume":"26","author":"P Harms","year":"2019","journal-title":"ACM Trans Comput Hum Interact"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1378\/chest.11-2863","article-title":"Radiation and chest CT scan examinations: what do we know?","volume":"142","author":"A Sarma","year":"2012","journal-title":"Chest"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.jacr.2009.11.010","article-title":"Analysis of appropriateness of outpatient CT and MRI referred from primary care clinics at an academic medical center: how critical is the need for improved decision support?","volume":"7","author":"B E Lehnert","year":"2010","journal-title":"J Am Coll Radiol"},{"issue":"12","key":"ref10","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1053\/crad.2001.0858","article-title":"Error in radiology","volume":"56","author":"R Fitzgerald","year":"2001","journal-title":"Clin 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and its association with use of computed tomography among patients with head injury","volume":"71","author":"A L Sharp","year":"2018","journal-title":"Ann Emerg Med"},{"issue":"07","key":"ref41","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.jacr.2017.03.005","article-title":"Clinical decision support decreases volume of imaging for low back pain in an urban emergency department","volume":"14","author":"A Min","year":"2017","journal-title":"J Am Coll Radiol"},{"issue":"07","key":"ref42","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1111\/acem.13195","article-title":"Embedded Clinical decision support in electronic health record decreases use of high-cost imaging in the emergency department: EmbED study","volume":"24","author":"K Bookman","year":"2017","journal-title":"Acad Emerg Med"},{"issue":"03","key":"ref43","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.ajem.2014.11.005","article-title":"Impact of clinical decision support on head 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