Ramin Khorasani MD, Abstract Co-Author: Nothing to Disclose

Joel Fallano DPT, Presenter: Nothing to Disclose

Reginald Burns Wilcox, Abstract Co-Author: Nothing to Disclose

Louise Isabel Schneider MD, Abstract Co-Author: Nothing to Disclose

Richard Griffey, Abstract Co-Author: Nothing to Disclose

Jacquelyn Sinclair, Abstract Co-Author: Nothing to Disclose

Wendy Mar, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

MRI for low back pain (LBP) is increasingly used in practice. Several published national guidelines, including those developed by the American College of Radiology (ACR) question the appropriateness of MRI in the routine work up of uncomplicated LBP, defined as absence of key clinical findings called ‘red flags’ (CRF). The purpose of this study was to assess the frequency of MRI for LBP requested by Primary Care Physicians (PCP) in the absence of CRF.

Study was performed at a 720-bed teaching hospital. We identified all outpatients who had MRI performed for LBP requested by PCPs using computerized physician order entry (CPOE, Percipio, Medicalis Corp, Kitchener, Ont.) during a 17-month period. We conducted implicit and explicit electronic medical record review using CRF described by the ACR appropriateness criteria on a random sample of patients.

We reviewed 50 randomly selected patient records from the 927 eligible patients. In 29 patients no CRF was documented. Of the CRF documented, recent significant trauma was present in 3 patients (3/50, 6%), known malignancy in 5 patients (5/50,10%), prolonged use of steroids or osteoporosis in 9 patients (9/50,18%), with 4 patients (4/50, 8%) over the age of 70.

Using ACR appropriateness criteria we found that a substantial portion (29/50,58%) of MRIs requested by PCPs for the workup of LBP had no documented CRF in the medical record. Further studies are needed to assess whether various medical management interventions that may include dissemination of published national guidelines could reduce this apparent overuse of MRI for uncomplicated LBP in the primary care setting.

Khorasani, R, Fallano, J, Wilcox, R, Schneider, L, Griffey, R, Sinclair, J, Mar, W, et al, , Is MRI for Low Back Pain Overused by Primary Care Physicians?.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4419810.html