Upper Extremity Surgeon Recommendations for Imaging Do Not Correspond with Imaging Appropriateness Guidelines

Area of Science:

• Musculoskeletal imaging
• Medical decision-making
• Health services research

Background:

• Rising utilization of advanced imaging like MRI and CT raises concerns about overuse.
• Imaging appropriateness guidelines aim to standardize evidence-based decisions and reduce unnecessary scans.
• This study compares expert use of advanced imaging for musculoskeletal conditions against established appropriateness recommendations.

Purpose of the Study:

• To evaluate the concordance between published imaging appropriateness guidelines and expert surgeon recommendations for upper extremity musculoskeletal conditions.
• To assess the utility of current guidelines in guiding advanced imaging decisions in clinical practice.

Main Methods:

• Collated 15 imaging guidelines for upper extremity advanced imaging.
• Surveyed 108 surgeons from the Science of Variation Group (SOVG) on 11 common upper extremity illness scenarios.
• Compared guideline recommendations with surgeon recommendations using Fisher's exact tests and assessed interobserver agreement with Fleiss' kappa.

Main Results:

• Most guidelines recommended advanced imaging (MRI/CT), while the majority of surgeons did not for the 11 scenarios.
• No significant correlation was found between surgeon and guideline recommendations (ρ = 0.28, p = 0.40).
• Slight interobserver agreement was observed among surgeons regarding imaging recommendations (kappa = 0.17).

Conclusions:

• Current imaging appropriateness guidelines for the upper extremity appear too permissive, offering limited clinical utility for surgeons.
• Significant variation exists among surgeons in advanced imaging recommendations, highlighting potential unreliability.
• Strategies are needed to align patient imaging decisions with their values and mitigate influences from misconceptions or surgeon habits.