Poster 2 Impact of a Reproducible Complex Partnership Between Physiatry and Emergency Medicine on Spine Care

Managing non‐serious low back pain in the emergency department: Time for a change?

“…Changing the ED policy so that radiologists only accepted imaging requests from emergency physicians who provided a justification for it, also reduced lumbar radiographs by 44% . A multidisciplinary protocol, including ED clinician education, patient intake forms, physiotherapy interventions and timely referral to specialists, reduced advanced imaging referrals by 26% . Moreover, training of clinicians and patient education is crucial to end the misconception that imaging is useful and necessary for the management of non‐serious low back pain.…”

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

“…A total of 603 unique studies were identified though the electronic and gray literature searches. Figure outlines the study selection process, which resulted in a total of five included studies . Twenty‐one studies were excluded for the following reasons: not a primary research study ( n = 13), ineligible study population (e.g., non‐ED population; n = 4), absence of a control group ( n = 2), or absence of an intervention aimed at reducing imaging ( n = 2).…”

“…All five studies, published between 1987 and 2017, implemented the intervention in the EDs of teaching hospitals in Canada, the United States, or the United Kingdom and employed before–after study designs. Three studies were published in peer‐reviewed journals and two studies were conference abstracts . All studies recruited adult patients presenting to the ED with LBP; however, no study specified how many patients presented with traumatic or nontraumatic LBP.…”

“…All studies recruited adult patients presenting to the ED with LBP; however, no study specified how many patients presented with traumatic or nontraumatic LBP. Two studies failed to report the number of patients enrolled in the pre‐ and postintervention groups . Reported imaging modality varied across studies and included simple radiography, computed tomography (CT) and myelography, magnetic resonance imaging (MRI), CT, and medical imaging unspecified .…”

“…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 . To support this goal, interventions to reduce image ordering among patients with LBP in both primary and acute care settings have been recommended. A recent systematic review demonstrated that interventions providing clinical decision support (CDS) in the primary care setting significantly decreased unnecessary imaging among LBP patients .…”