Adopting and Adapting Clinical Practice Guidelines for the Use of Baseline MRI in Acute Spinal Cord Injury in a Developing Country

Abstract

Background: Spinal cord injury (SCI) imposes a heavy burden on patients and health systems. Magnetic resonance imaging (MRI) provides a detailed evaluation of the spinal cord and associated soft tissues in a non-invasive manner. Objectives: We aimed to adopt and adapt suitable recommendations and guidelines in Iran for the utilization of MRI in the management of acute SCI patients based on available international guidelines and through a systematic review of literature, followed by guideline development based on the Delphi technique. Methods: After the primary systematic search and review of the literature and guidelines on the use of MRI in the management of acute SCI, all relevant recommendations were retrieved. Desired recommendations were then extracted and presented to our expert panel through the Delphi technique. The final decision for the inclusion or adaptation of recommendations to improve SCI care in the Iranian population was made through expert panel meetings. Results: Our literature search resulted in 769 records. Only three records provided recommendations on the role of MRI in the management of acute SCI, from which a total of six recommendations were extracted. Of these, the two final recommendations were extracted: (I) “Use MRI in adult patients with acute SCI prior to surgical interventions, when feasible, to facilitate clinical decision making,” and (II) “Use MRI in adult patients in the acute period following SCI and before or after surgical interventions (only when fixation is not used) to improve the prediction of neurologic outcomes following acute SCI.” Conclusions: The final recommendations help appropriately use MRI in patients with acute SCI, facilitating the management of these patients and improving their outcomes. This study shows that it is possible for developing countries to indigenize international guidelines, and with minor changes, an appropriate therapeutic framework can be created to improve service delivery.