Care-pathway decision support improves non-specialist vet clinical decision making in dogs with myelopathy.

Care pathway decision support significantly improves non-specialist vets' differential diagnosis prioritization in canine myelopathy cases.

This crossover study evaluated whether care pathway (CP) clinical decision support tools could improve non-specialist veterinarians' clinical decision-making in dogs presenting with myelopathy causing para/tetraparesis or plegia. Eight historical canine myelopathy cases from a university referral hospital were used to develop a CP that prioritizes differential diagnoses and provides management recommendations. Forty-five non-specialist veterinarians and 17 final-year veterinary students participated, each answering case-based questions both with (CP+) and without (CP-) decision support, with randomized question order in a crossover design. Answers were scored against a pre-agreed expert consensus (maximum 100 points). Results demonstrated statistically significant improvements in both domains when using CP support: differential diagnosis listing and prioritization improved by a mean of 40.4 points (95% CI [36.4, 44.4]; P < .05), and management decision scores improved by 7.1 points (95% CI [2.3, 11.6]; P < .05). The substantially larger improvement seen in differential diagnosis prioritization compared to management decisions suggests that knowledge engineering tools are particularly valuable in helping non-specialists systematically organize and rank diagnostic possibilities. The authors conclude that CP-based clinical decision support represents a promising adjunctive tool for non-specialist veterinarians managing neurological cases, potentially bridging the knowledge gap between general practitioners and specialists, and improving patient care consistency in settings without immediate access to veterinary neurology specialists.

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