{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T15:29:22Z","timestamp":1767713362819},"reference-count":44,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,1,22]],"date-time":"2018-01-22T00:00:00Z","timestamp":1516579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100009192","name":"Alberta Innovates","doi-asserted-by":"publisher","award":["PRIHS\u20102"],"award-info":[{"award-number":["PRIHS\u20102"]}],"id":[{"id":"10.13039\/501100009192","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007582","name":"Alberta Health Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007582","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Appropriate use of imaging for adult patients with cervical spine (C\u2010spine) injuries in the emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) is a longstanding issue. Guidance for C\u2010spine ordering exists; however, the effectiveness of the decision support implementation in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> is not well studied. This systematic review examines the implementation and effectiveness of evidence\u2010based interventions aimed at reducing C\u2010spine imaging in adults presenting to the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> with neck trauma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Six electronic databases and the gray literature were searched. Comparative intervention studies were eligible for inclusion. Two independent reviewers screened for study eligibility, study quality, and extracted data. The change in imaging was reported using individual odds ratios (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>s) with 95% confidence intervals (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>s) using random effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 990 unique citations were screened for relevance of which six before\u2013after studies and one randomized controlled trial were included. None of the studies were assessed as high quality. Interventions consisted primarily of locally developed guidelines or established clinical decision rules such as the <jats:styled-content style=\"fixed-case\">NEXUS<\/jats:styled-content> or the Canadian C\u2010spine rule. Overall, implementation of interventions aimed at reducing C\u2010spine image ordering resulted in a statistically significant reduction in imaging (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\u00a0=\u00a00.69, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0= 0.51\u20130.93); however, heterogeneity was high (I<jats:sup>2<\/jats:sup>\u00a0=\u00a082%). Subgroup analysis revealed no differences between studies that specified enrolling alert and stable patients compared to unspecified trauma (p\u00a0=\u00a00.81) or between studies employing multifaceted versus nonmultifaceted interventions (p\u00a0=\u00a00.66). While studies generally provided details on implementation strategies (e.g., teaching sessions, pocket cards, posters, computerized decision support) the effectiveness of these implementation strategies were frequently not reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is moderate evidence regarding the effectiveness of interventions to reduce C\u2010spine image ordering in adult patients seen in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> with neck trauma. Given the national and international focus on improving appropriateness and reducing unnecessary C\u2010spine imaging through campaigns such as Choosing Wisely, additional interventional research in this field is warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13364","type":"journal-article","created":{"date-parts":[[2017,12,19]],"date-time":"2017-12-19T13:43:59Z","timestamp":1513691039000},"page":"672-683","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Effectiveness of Implementing Evidence\u2010based Interventions to Reduce C\u2010spine Image Ordering in the Emergency Department: A Systematic Review"],"prefix":"10.1111","volume":"25","author":[{"given":"Shashwat","family":"Desai","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chaocheng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott W.","family":"Kirkland","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynette D.","family":"Krebs","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Keto\u2010Lambert","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian H.","family":"Rowe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Alberta Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,1,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2009.1138"},{"key":"e_1_2_7_3_1","unstructured":"National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables. 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