Adrian Traeger1, Gustavo C Machado1, Sally Bath1, Martin Tran1, Lucinda Roper1, Crystian Oliveira1,2, Aimie Peek3, Danielle Coombs1, Amanda Hall4, Elise Tcharkhedian5, Chris Maher1. 1. The University of Sydney, Faculty of Medicine and Health, Institute for Musculoskeletal Health, Sydney School of Public Health, Level 10 North, King George V Building. Royal Prince Alfred Hospital. Missenden Road, Sydney, NSW, Australia. 2. Physical Therapy Department, Faculty of Science and Technology, Sao Paulo State University, Presidente Prudente, Brazil. 3. The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences. Cumberland Campus, 75 East Street, Lidcombe, Sydney, NSW, Australia. 4. Memorial University, Faculty of Medicine, St. John's, NL, Canada. 5. Liverpool Hospital, Physiotherapy Department, Southwest Sydney Local Health District, Liverpool, Sydney, NSW, Australia.
Abstract
BACKGROUND: Imaging for low back pain is widely regarded as a target for efforts to reduce low value care. We aimed to estimate the prevalence of overuse and underuse of lumbar imaging in the Emergency Department. METHODS: Retrospective chart review study of five public hospital Emergency Departments in Sydney, Australia, in 2019/20. We reviewed the clinical charts of consecutive adult patients who presented with a complaint of low back pain and extracted clinical features relevant to a decision to request lumbar imaging. We estimated the proportion of encounters where a decision to request lumbar imaging was inappropriate (overuse) or where a clinician did not request an appropriate and informative lumbar imaging test when indicated (underuse). RESULTS: 649 patients presented with a complaint of low back pain of which 158 (24.3%) were referred for imaging. 79 (12.2%) had a combination of features suggesting lumbar imaging was indicated according to clinical guidelines. The prevalence of overuse and underuse of lumbar imaging was 8.8% (57 of 649 cases, 95%CI 6.8% to 11.2%) and 4.3% (28 of 649 cases, 95%CI 3.0% to 6.1%), respectively. 13 cases were classified as underuse because the patient was referred for an uninformative imaging modality (e.g. referred for radiography for suspected cauda equina syndrome). CONCLUSION: In this study of emergency care there was evidence of overuse of lumbar imaging, but also underuse through failure to request lumbar imaging when indicated or referral for an uninformative imaging modality. These three issues seem more important targets for quality improvement than solely focusing on overuse.
BACKGROUND: Imaging for low back pain is widely regarded as a target for efforts to reduce low value care. We aimed to estimate the prevalence of overuse and underuse of lumbar imaging in the Emergency Department. METHODS: Retrospective chart review study of five public hospital Emergency Departments in Sydney, Australia, in 2019/20. We reviewed the clinical charts of consecutive adult patients who presented with a complaint of low back pain and extracted clinical features relevant to a decision to request lumbar imaging. We estimated the proportion of encounters where a decision to request lumbar imaging was inappropriate (overuse) or where a clinician did not request an appropriate and informative lumbar imaging test when indicated (underuse). RESULTS: 649 patients presented with a complaint of low back pain of which 158 (24.3%) were referred for imaging. 79 (12.2%) had a combination of features suggesting lumbar imaging was indicated according to clinical guidelines. The prevalence of overuse and underuse of lumbar imaging was 8.8% (57 of 649 cases, 95%CI 6.8% to 11.2%) and 4.3% (28 of 649 cases, 95%CI 3.0% to 6.1%), respectively. 13 cases were classified as underuse because the patient was referred for an uninformative imaging modality (e.g. referred for radiography for suspected cauda equina syndrome). CONCLUSION: In this study of emergency care there was evidence of overuse of lumbar imaging, but also underuse through failure to request lumbar imaging when indicated or referral for an uninformative imaging modality. These three issues seem more important targets for quality improvement than solely focusing on overuse.
Authors: Lance M Mabry; Richard Severin; Angela S Gisselman; Michael D Ross; Todd E Davenport; Brian A Young; Aaron P Keil; Don L Goss Journal: J Man Manip Ther Date: 2022-08-13