Imaging during low back pain ED visits: a claims-based descriptive analysis

Schlemmer, Erin; Mitchiner, James C.; Brown, Michael D.; Wasilevich, Elizabeth

doi:10.1016/j.ajem.2014.12.060

Cited by 34 publications

(37 citation statements)

References 10 publications

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“…MRI utilization rates do not differ in observation versus admitted patients . Some MRI use does not meet appropriateness criteria . Cardiac stress testing is another non‐CT example of increasing overtesting.…”

Section: Relevance Of “Preventing Overdiagnosis” For Emergency Medicinementioning

confidence: 99%

Overtesting and the Downstream Consequences of Overtreatment: Implications of “Preventing Overdiagnosis” for Emergency Medicine

Carpenter

Raja

Brown

2015

Academic Emergency Medicine

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Overtesting, the downstream consequences of overdiagnosis, and overtreatment of some patients are topics of growing debate within emergency medicine (EM). The "Preventing Overdiagnosis" conference, hosted by The Dartmouth Institute for Health Policy and Clinical Practice, with sponsorship from consumer organizations, medical journals, and academic institutions, is evidence of an expanding interest in this topic. However, EM represents a compellingly unique environment, with increased decision density tied to high stakes for patients and providers with missed or delayed diagnoses in a professional atmosphere that does not tolerate mistakes. This article reviews the relevance of this reductionist paradigm to EM, provides a first-hand synopsis of the first "Preventing Overdiagnosis" conference, and assesses barriers to moving the concept of less test ordering to reality.

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Section: Relevance Of “Preventing Overdiagnosis” For Emergency Medicinementioning

confidence: 99%

Overtesting and the Downstream Consequences of Overtreatment: Implications of “Preventing Overdiagnosis” for Emergency Medicine

Carpenter

Raja

Brown

2015

Academic Emergency Medicine

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“…Forty percent of diagnostic imaging referrals were not consistent with imaging guidelines, a figure consistent with LBP imaging referrals in USA EDs . Over‐imaging of MSP has been identified as an area of significant monetary waste within healthcare systems and guidelines discourage the routine use .…”

Section: Discussionmentioning

confidence: 87%

“…Discordance between recommended high‐quality care and management practices of NTMSP in primary care have previously been reported . One study reported that 15% of patients presenting to an ED in the USA with LBP were administered diagnostic imaging when it was not indicated . Higher quality care has the potential to decrease the societal burden imposed by NTMSP by reducing individual morbidity, healthcare utilisation and cost.…”

Section: Introductionmentioning

confidence: 99%

Non‐traumatic musculoskeletal pain in Western Australian hospital emergency departments: A clinical audit of the prevalence, management practices and evidence‐to‐practice gaps

Baker

Kessler

Kaiser

et al. 2019

Emerg Medicine Australasia

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Documented management practices are discordant with guideline recommendations. Strategies to improve the concordance between management and guideline recommendations are needed. Key findings• NTMSP is a relatively common reason for ED presentation. • Documented management practices are discordant with guideline recommendations. • Strategies to improve the concordance between management and guideline recommendations are needed.

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“…In addition, overtesting can result in over‐diagnosis and overtreatment, which can further increase costs and reduce quality of care for patients . Despite these concerns, the use of simple and advanced imaging for LBP presentations remains high …”

mentioning

confidence: 99%

“…Although some evidence suggests that patients with LBP in the ED are appropriately imaged based on the American College of Radiology appropriateness criteria, other studies have reported that 30% of patients in which imaging for LBP was not indicated received imaging, suggesting substantial practice variation across EDs. Aligning imaging practices with appropriateness criteria is a primary goal of international campaigns such as Choosing Wisely and consensus‐based research agendas in emergency medicine .…”

mentioning

confidence: 99%

Effectiveness of Interventions to Decrease Image Ordering for Low Back Pain Presentations in the Emergency Department: A Systematic Review

Liu

Desai

Krebs

et al. 2018

Academic Emergency Medicine

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While imaging of LBP has been identified as a key area of imaging overuse (e.g., Choosing Wisely recommendation), evidence on interventions to reduce image ordering for ED patients with LBP is sparse. There is some evidence to suggest that interventions can reduce the use of simple imaging in LBP in the ED; however, a shift in imaging modality has also been demonstrated. Additional studies employing higher-quality methods and measuring intervention fidelity are strongly recommended to further explore the potential of ED-based interventions to reduce image ordering for this patient population.

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Imaging during low back pain ED visits: a claims-based descriptive analysis

Cited by 34 publications

References 10 publications

Overtesting and the Downstream Consequences of Overtreatment: Implications of “Preventing Overdiagnosis” for Emergency Medicine

Overtesting and the Downstream Consequences of Overtreatment: Implications of “Preventing Overdiagnosis” for Emergency Medicine

Non‐traumatic musculoskeletal pain in Western Australian hospital emergency departments: A clinical audit of the prevalence, management practices and evidence‐to‐practice gaps

Effectiveness of Interventions to Decrease Image Ordering for Low Back Pain Presentations in the Emergency Department: A Systematic Review

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