Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good

Flynn, Timothy W.; Smith, Britt; Chou, Roger

doi:10.2519/jospt.2011.3618

Cited by 127 publications

(82 citation statements)

References 52 publications

(72 reference statements)

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“…Furthermore, unnecessary returns to the operating room without clear indications such as for an asymptomatic seroma that is likely to resolve with time can be detrimental without adding any discernable clinical benefit. Unfortunately, with the ease and availability of modern cross-sectional imaging, it is easy to cloud the clinical picture with incidental or distracting additional information [2], for example, in the setting of postoperative fever. Our study demonstrates that fluid collections are common in the acute postoperative period, decrease with time, and are not necessarily associated with an increased risk of infection.…”

Section: Discussionmentioning

confidence: 99%

“…Whether these fluid collections increase the risk of infection is unknown. Questions/purposes The purposes of this study were to determine (1) the percentage of patients who develop postoperative fluid collections in posttraumatic amputations and the natural course of the collection; (2) whether patients who develop these collections are at increased risk for infection; and to ask (3) are there objective clinical or radiologic signs that are associated with likelihood of infection when a fluid collection is present?…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, we asked (1) how common are fluid collections are in the combat amputee, and do they resolve over time; (2) is the presence of a fluid collection associated with a higher likelihood of infection; and finally, (3) are there objective clinical or radiologic signs that are associated with likelihood of infection when a fluid collection is present?…”

Section: Introductionmentioning

confidence: 99%

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Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Polfer

Hoyt

Senchak

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background In the acute postoperative period, fluid collections are common in lower extremity amputations. Whether these fluid collections increase the risk of infection is unknown. Questions/purposes The purposes of this study were to determine (1) the percentage of patients who develop postoperative fluid collections in posttraumatic amputations and the natural course of the collection; (2) whether patients who develop these collections are at increased risk for infection; and to ask (3) are there objective clinical or radiologic signs that are associated with likelihood of infection when a fluid collection is present?Methods We performed a review of all 300 patients injured in combat operations who sustained at least one major lower extremity amputation (at or proximal to the tibiotalar joint) and were treated definitively at our institution between March 2005 and April 2009. We segregated the groups based on whether cross-sectional imaging was performed less than 3 months (early group) after closure, greater than 3 months (late group) after closure, or not at all (control group, baseline frequency of infection). Our primary study cohort where those patients with a fluid collection in the first three months. The clinical course was reviewed and the primary outcome was a return to the operating room for irrigation and débridement with positive cultures. For those patients with cross-sectional imaging, we also collected objective clinical parameters within 24 hours of the scan (white blood cell count, maximum temperature, presence of bacteremia, tachycardia, oxygen desaturation), extremity examination (presence of erythema, warmth, and/or drainage), and characteristics of the fluid collections seen (size of the fluid collection, Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Polfer

Hoyt

Senchak

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Placing too much emphasis on physical abnormalities can induce a negative self-perception of health and lead to fear avoidance and pain catastrophizing behaviors, a situation that may predispose individuals to chronic pain (Ash et al, 2008;Flynn et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Simple things matter! How reassurance and pain management strategies can improve outcomes in physiotherapy

Léonard

Tousignant-Laflamme²,

Mercier³

2013

International Journal of Rehabilitation Research

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“…The rate of back complaints and degenerative spinal changes seen on plain film or other more sensitive and specific imaging studies (i.e., CT or MRI) is very high (50-80%) but may not correlate well with symptoms [26] [27] [28,29] . Some of the highest levels of vertical vibration were measured in off-road construction or mine vehicles and forklifts.…”

Section: Vol 30 No 3 2011 Eckardt Johanningmentioning

confidence: 99%

Diagnosis of Whole-Body Vibration Related Health Problems in Occupational Medicine

Johanning¹

2011

Journal of Low Frequency Noise, Vibration and Active Control

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Occupational whole-body vibration (WBV) exposed workers may report nonspecific health complaints or debilitating physical disorders. Health care providers and safety professionals may not recognize such occupational injuries and be unfamiliar with appropriate exposure assessment. Method: Review of peer-reviewed clinical studies and publications, medical evidence, differential diagnostic evaluation protocols, surveillance programs, national and international standards, and intervention recommendations regarding WBV. Results: There are well-designed epidemiological studies showing that prolonged and increasing exposures to WBV can primarily result in musculoskeletal or neurological disorders of the spine. Less frequent and weaker evidence exist for organ damage that include intestinal organs, vascular system and other body parts. In some countries spinal injury caused by longterm occupational WBV exposure is compensable. Many physicians and occupational safety experts seem to be unfamiliar with the wide spectrum of health complaints and the proper evaluation of WBV-exposed patients following expert reviews and international guidelines/standards. Detailed protective regulations and provisions exist primarily in highly industrialized countries with good occupational health systems. The causal diagnosis should be based on medical findings, a differential diagnostic methodology and adequate work exposure assessment and documentation of WBV. Conclusion: A proper WBV-related injury diagnosis includes a critical review of the work history, exposure data assessment and the clinical differential diagnostic evaluation. Many health care providers receive little or no training in the recognition of WBV-related injuries and case management. WBV health surveillance should assess the health status of WBV-exposed workers and address preventive measures for employers and employees.

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Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good

Cited by 127 publications

References 52 publications

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Simple things matter! How reassurance and pain management strategies can improve outcomes in physiotherapy

Diagnosis of Whole-Body Vibration Related Health Problems in Occupational Medicine

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