Guidelines for lumbar spine radiography in acute low back pain: effect of implementation in an accident and emergency department.

Guidelines for lumbar spine radiography were agreed by consultation between staff in the radiology, accident and emergency and neurosurgical departments of a large teaching hospital. Study of 322 consecutive patients over an eight month period showed that the proportion of patients referred for radiography was reduced from 48.4% to 27.2% following introduction of the guidelines (p = 0.0002). Successful use of such guidelines requires cooperation between clinical and radiological staff and frequent review of performance.