Purpose
This study aims to evaluate the clinical scenarios addressed by the EURO-2000 guidelines
and the ACR appropriateness criteria for referring children to MRI and assessing the
referring physician compliance with both guidelines.
Methods
In January 2022, clinical scenarios reported in the last 1000 consecutive MRI requests
for children (0−16 years) in one university children's hospital and two general university
hospitals in Belgium, Europe, were retrospectively matched to the EURO-2000 guidelines
and ACR appropriateness criteria. The number of clinical scenarios addressed and the
justification for MRI referral were independently assessed for both guidelines. Pooled
data from the three centers were evaluated and then analyzed by center, body area
and prescriber using McNemar's test for paired proportions and χ2-tests unpaired proportions.
Results
After excluding incomplete or missing MRI requests, 2932 of 3000 requests were included
in the analysis. Overall, out of 2932 clinical scenarios, 1229 (37.99%) were addressed
by EURO-2000 and 1081 (36.37%) were addressed by the ACR appropriateness criteria
(McNemar test, p = 0.12). The proportions of clinical scenarios covered by the two guidelines were
statistically similar when comparing centers, but varied across body regions (p < 0.001) and referring physician specialty (p between 0.75 and 0.001). EURO-2000 guidelines provided better coverage for head and
spine (p < 0.05), while the ACR appropriateness criteria provided broader coverage for abdomen,
pelvis, and musculoskeletal system (p < 0.0001). For addressed clinical scenarios, prescriber compliance for both guidelines
was excellent with > 94% of justified MRI examinations in all the centers.
Conclusions
Both the EURO-2000 guidelines and the ACR appropriateness criteria did not address
two-thirds of clinical scenarios in children. Head and neck, chest and abdominal-pelvic
examinations are the anatomic regions which should receive a specific attention for
the future implementation of evidence-based clinical decision support tools for all
referring specialists.
Key Words
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Article info
Publication history
Published online: December 24, 2022
Accepted:
December 8,
2022
Received in revised form:
December 7,
2022
Received:
November 19,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
