E Millán Ortuondo1, A Cabrera Zubizarreta2, J Muñiz Saitua3, C Sola Sarabia3, J Zubia Arratibel4. 1. Subdirección de Asistencia Sanitaria, Osakidetza-Servicio Vasco de Salud, Vitoria, España. Electronic address: eduardo.millanortuondo@osakidetza.net. 2. Osatek Sociedad Pública del Departamento de Sanidad y Consumo, Gobierno Vasco, Galdakao, España. 3. Subdirección de Asistencia Sanitaria, Osakidetza-Servicio Vasco de Salud, Vitoria, España. 4. Dirección Territorial de Bizkaia, Departamento de Sanidad y Consumo, Bilbao, España.
Abstract
INTRODUCTION: Low back pain is a common disorder that generates many medical consultations. Magnetic Resonance Imaging (MRI) is commonly used in the clinical management of some of these patients. However, the cost of inappropriate MRI use is high, so there is a need to develop guidelines to help physicians make correct decisions and optimize available resources. OBJECTIVE: To determine the main clinical indications for MRI scanning in adults with low back pain. MATERIAL AND METHODS: The RAND/UCLA appropriateness method was used: After a systematic review (May 2012), a list of the clinical indications for MRI scanning in patients with low back pain was prepared. A multidisciplinary expert panel scored each indication from 1, «totally inappropriate» to 9, «totally appropriate». A first on-line round, an in-person panel meeting, where results of the first round were discussed, and a final second on-line round were arranged. A clinical indication was considered appropriate if the median score was 6.5 or higher, and there was agreement between experts (IPRAS index was used). RESULTS: An MRI test is considered appropriate if cancer, spinal infection or a fracture, even with a negative X-ray test is suspected.; if there is inflammatory back pain; severe/progressive neurological deficit; severe and progressive low back pain; subacute or chronic low back pain with radicular involvement unresponsive to conservative therapy. CONCLUSIONS: Clinical indications for a MRI scanning are based on the suspicion of a secondary serious pathology. This methodology helps to set clinical indications for MRI, and may be of great value for both clinicians and health managers.
INTRODUCTION:Low back pain is a common disorder that generates many medical consultations. Magnetic Resonance Imaging (MRI) is commonly used in the clinical management of some of these patients. However, the cost of inappropriate MRI use is high, so there is a need to develop guidelines to help physicians make correct decisions and optimize available resources. OBJECTIVE: To determine the main clinical indications for MRI scanning in adults with low back pain. MATERIAL AND METHODS: The RAND/UCLA appropriateness method was used: After a systematic review (May 2012), a list of the clinical indications for MRI scanning in patients with low back pain was prepared. A multidisciplinary expert panel scored each indication from 1, «totally inappropriate» to 9, «totally appropriate». A first on-line round, an in-person panel meeting, where results of the first round were discussed, and a final second on-line round were arranged. A clinical indication was considered appropriate if the median score was 6.5 or higher, and there was agreement between experts (IPRAS index was used). RESULTS: An MRI test is considered appropriate if cancer, spinal infection or a fracture, even with a negative X-ray test is suspected.; if there is inflammatory back pain; severe/progressive neurological deficit; severe and progressive low back pain; subacute or chronic low back pain with radicular involvement unresponsive to conservative therapy. CONCLUSIONS: Clinical indications for a MRI scanning are based on the suspicion of a secondary serious pathology. This methodology helps to set clinical indications for MRI, and may be of great value for both clinicians and health managers.
Keywords:
Consenso; Consensus; Diagnostic imaging; Diagnóstico por imagen; Dolor lumbar; Imagen por resonancia magnética; Low back pain; Magnetic resonance imaging