Lumbosacral Spinal Imaging for Patients Presenting to the Emergency Department With Nontraumatic Low Back Pain

Berezin, Linor; Thompson, Courtney; Rojas-Luengas, Vanessa; Borgundvaag, Bjug; McLeod, Shelley

doi:10.1016/j.jemermed.2019.12.017

Cited by 7 publications

(12 citation statements)

References 9 publications

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“…Recommendations and guidelines such as the National Institute for Health and Care Excellence’s (NICE’s) “Do-not-do list,” iRefer, iGuide and the international Choosing Wisely campaign have been introduced to reduce overutilization in health care and reduce low-value care, including diagnostic imaging [ 9 – 11 ]. So far, the impact of such efforts is reportedly low, as patient expectations of advanced diagnostic tests, lack of knowledge among health care professionals on the right use of imaging, established clinical practice, fear of malpractice, and fee-for-service reimbursement systems continue to drive the use of low-value care [ 6 , 12 – 16 ]. Knowledge about low-value imaging in terms of characteristics, quantities and contexts is warranted to enable adequate prioritizing of resource utilization and designing de-implementation initiatives.…”

Section: Introductionmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: Introductionmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…Several interventions to reduce low-value imaging have been evaluated in the literature, including guidelines such as iRefer, iGuide, as well as national and international initiatives such as the National Institute for Health and Care Excellence (NICE) “Do-not-do list,” and the Choosing Wisely campaign [ 9 – 12 ]. However, the effect of such efforts on low-value diagnostic imaging has been limited due to barriers such as financial incentives, practice behavior, self-referral, lack of feedback, patient expectations, and duplicate imaging examinations [ 5 , 11 , 13 – 17 ]. Some interventions even seem to increase the use of inappropriate imaging [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Kjelle

Andersen

Soril

et al. 2021

BMC Health Serv Res

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Background It is estimated that 20–50% of all radiological examinations are of low value. Many attempts have been made to reduce the use of low-value imaging. However, the comparative effectiveness of interventions to reduce low-value imaging is unclear. Thus, the objective of this systematic review was to provide an overview and evaluate the outcomes of interventions aimed at reducing low-value imaging. Methods An electronic database search was completed in Medline – Ovid, Embase-Ovid, Scopus, and Cochrane Library for citations between 2010 and 2020. The search was built from medical subject headings for Diagnostic imaging/Radiology, Health service misuse or medical overuse, and Health planning. Keywords were used for the concept of reduction and avoidance. Reference lists of included articles were also hand-searched for relevant citations. Only articles written in English, German, Danish, Norwegian, Dutch, and Swedish were included. The Mixed Methods Appraisal Tool was used to appraise the quality of the included articles. A narrative synthesis of the final included articles was completed. Results The search identified 15,659 records. After abstract and full-text screening, 95 studies of varying quality were included in the final analysis, containing 45 studies found through hand-searching techniques. Both controlled and uncontrolled before-and-after studies, time series, chart reviews, and cohort studies were included. Most interventions were aimed at referring physicians. Clinical practice guidelines (n = 28) and education (n = 28) were most commonly evaluated interventions, either alone or in combination with other components. Multi-component interventions were often more effective than single-component interventions showing a reduction in the use of low-value imaging in 94 and 74% of the studies, respectively. The most addressed types of imaging were musculoskeletal (n = 26), neurological (n = 23) and vascular (n = 16) imaging. Seventy-seven studies reported reduced low-value imaging, while 3 studies reported an increase. Conclusions Multi-component interventions that include education were often more effective than single-component interventions. The contextual and cultural factors in the health care systems seem to be vital for successful reduction of low-value imaging. Further research should focus on assessing the impact of the context in interventions reducing low-value imaging and how interventions can be adapted to different contexts.

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“…Several guidelines have been published to guide the physician diagnostic workout to avoid unnecessary imaging or testing. [ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ] Most of them recommend further studies if symptoms last longer than six weeks or the so-called “red flags” are present [ Table 2 ].…”

Section: Methodsmentioning

confidence: 99%

Sciatica. Management for family physicians

Aguilar-Shea

Gallardo-Mayo

Sanz-Gonzalez

et al. 2022

Journal of Family Medicine and Primary Care

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Sciatica or lower back pain with sciatic radiation is a frequent medical problem in primary care. The aim of this article is to better inform medical practitioners on diagnosis and management of lower back pain with sciatic radiation. Updated information on sciatica management is important for family physicians. Here, we review the available literature on sciatica. Relevant articles were identified via a literature search in PubMed by focusing on the following key points: diagnostic and definition criteria, red flags, and therapy. In addition, the authors’ clinical experience has been utilised to propose a schema to assist in the assessment and treatment of sciatica in a primary care setting. Sciatica diagnosis is based on a careful history and clinical examination. Imaging is usually not necessary at first; testing with X-ray and MRI are key to diagnosing lumbar instability and herniated discs. Management includes physical conditioning, proper pain management, and surgery as a last resort. Pain treatment includes analgesics, anticonvulsants and muscle relaxants. A more aggressive approach would include epidural infiltrations and radiofrequency.

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Lumbosacral Spinal Imaging for Patients Presenting to the Emergency Department With Nontraumatic Low Back Pain

Cited by 7 publications

References 9 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Sciatica. Management for family physicians

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