• Nathan M Finnerty, Robert M Rodriguez, Christopher R Carpenter, Benjamin C Sun, Nik Theyyunni, Robert Ohle, Kenneth W Dodd, Elizabeth M Schoenfeld, Kendra D Elm, Jeffrey A Kline, James F Holmes, and Nathan Kuppermann.
• Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH.
• Acad Emerg Med. 2015 Dec 1;22(12):1406-16.

BackgroundMajor gaps persist in the development, validation, and implementation of clinical decision rules (CDRs) for diagnostic imaging.ObjectivesThe objective of this working group and article was to generate a consensus-based research agenda for the development and implementation of CDRs for diagnostic imaging in the emergency department (ED).MethodsThe authors followed consensus methodology, as outlined by the journal Academic Emergency Medicine (AEM), combining literature review, electronic surveys, telephonic communications, and a modified nominal group technique. Final discussions occurred in person at the 2015 AEM consensus conference.ResultsA research agenda was developed, prioritizing the following questions: 1) what are the optimal methods to justify the derivation and validation of diagnostic imaging CDRs, 2) what level of evidence is required before disseminating CDRs for widespread implementation, 3) what defines a successful CDR, 4) how should investigators best compare CDRs to clinical judgment, and 5) what disease states are amenable (and highest priority) to development of CDRs for diagnostic imaging in the ED?ConclusionsThe concepts discussed herein demonstrate the need for further research on CDR development and implementation regarding diagnostic imaging in the ED. Addressing this research agenda should have direct applicability to patients, clinicians, and health care systems.© 2015 by the Society for Academic Emergency Medicine.

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