Jeffrey Gil Jarvik MD, MPH, Presenter: Stockholder, PhysioSonics, Inc Consultant, HealthHelp, LLC Co-editor, Springer Science+Business Media Deutschland GmbH Royalties, Springer Science+Business Media Deutschland GmbH Travel support, General Electric Company

Laura S. Gold PhD, Abstract Co-Author: Nothing to Disclose

Bryan A. Comstock, Abstract Co-Author: Nothing to Disclose

Patrick Heagerty, Abstract Co-Author: Nothing to Disclose

Andrew Avins, Abstract Co-Author: Nothing to Disclose

Zoya Bauer, Abstract Co-Author: Nothing to Disclose

Brian W. Bresnahan PhD, Abstract Co-Author: Stockholder, Johnson & Johnson Investigator, General Electric Company Consultant, General Electric Company Consultant, Johnson and Johnson Consultant, Novartis AG

Janna Friedly, Abstract Co-Author: Nothing to Disclose

Katherine T. James, Abstract Co-Author: Nothing to Disclose

Larry G. Kessler, Abstract Co-Author: Consultant, General Electric Company

Srdjan Nedeljkovic, Abstract Co-Author: Nothing to Disclose

Jason Schwalb, Abstract Co-Author: Nothing to Disclose

Xu Shi, Abstract Co-Author: Nothing to Disclose

Sean D. Sullivan PhD, Abstract Co-Author: Nothing to Disclose

Judith Turner, Abstract Co-Author: Nothing to Disclose

Richard A. Deyo MD, MPH, Abstract Co-Author: Nothing to Disclose

To compare the effects of early imaging (within six weeks of presentation) to no early imaging with respect to function, pain and subsequent resource utilization in senior patients with new primary care visits for back pain without radiculopathy.

We analyzed data from 5,239 patients enrolled in the Back pain Outcomes using Longitudinal Data (BOLD) Study, a prospective cohort of patients ≥65 years old with a new primary care visit for back pain. This analysis includes patients completing 1 year of follow-up by 11/2013 (n=3881) but will present data from the entire cohort. Our primary outcome was back-related disability measured by the Roland-Morris Disability Questionnaire (RMDQ) at 12 months. Secondary outcomes included 0-10 numerical rating scale of average back pain in the past week, EQ5D and cumulative 12-month back-related relative value units (RVUs). We performed propensity score matching to construct comparable early imaging and no-early imaging groups creating two propensity-matched comparisons: 1) early x-ray vs. no-early imaging (n=652/group); 2) early CT or MR vs. no-early imaging (n=312/group).We used separate generalized estimating equation models on the matched samples to compare outcome measures between the early vs. no early imaging groups. We adjusted each model for site and important precision variables.

There were statistically significant but clinically unimportant differences between patients who received early x-ray compared to patients who did not (adjusted 12mo RMDQ: early x-ray: 8.4±6.5 vs. 9.1±6.9 no-early imaging;p=0.04; adjusted 12mo EQ5D-Index (high=better) early x-ray: 0.79±0.16 vs. no-early imaging: 0.77±0.18;p=0.02). There was no difference in adjusted 12-month RMDQ or EQ5D in the early CT/MR group vs. no-early imaging. Total RVUs were ~2.2 times greater in the early CT/MR group (170±400) as in the no-early imaging group (77±230,p=0.001). The difference for spine-related RVUs was ~10 times higher in the early CT/MR group compared with the no-early imaging group (120±350 vs. 12±72,p=0.0001).

Senior patients undergoing early imaging had similar 12-month RMDQ, pain and EQ5D scores to patients not undergoing early imaging but had substantially higher back-related and total RVUs.

Guidelines for imaging seniors with back pain should have similar limitations to those in younger patients and not exempt seniors simply because of their age.

Jarvik, J, Gold, L, Comstock, B, Heagerty, P, Avins, A, Bauer, Z, Bresnahan, B, Friedly, J, James, K, Kessler, L, Nedeljkovic, S, Schwalb, J, Shi, X, Sullivan, S, Turner, J, Deyo, R, Early Imaging in Senior Primary Care Patients with Back Pain: Impact on Resource Utilization and Patient Outcomes.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007387.html