Sishir Rao MD, Presenter: Nothing to Disclose

Sevith Rao, Abstract Co-Author: Nothing to Disclose

Laura Louise Avery MD, Abstract Co-Author: Nothing to Disclose

Hani H. Abujudeh MD, MBA, Abstract Co-Author: Research Grant, Bracco Group Consultant, RCG HealthCare Consulting Author, Oxford University Press

Sanjay Saini MD, Abstract Co-Author: Nothing to Disclose

Anand M. Prabhakar MD, Abstract Co-Author: Nothing to Disclose

Americans spend $50 billion yearly on low back pain (LBP). Acute LBP is often self-limited, without the need for imaging. Imaging plays an important role for patients with progressive neurologic deficits and refractory pain for greater than six weeks. The ACR Appropriateness Criteria is an important tool in the clinician’s arsenal to provide appropriate, cost conscious medical care. We aimed to assess the prevalence of appropriate imaging among patients who presented with LBP to a level 1 ER.

We retrospectively searched our ER records for patients who presented with a CC of “Back Pain” from Jan-Feb 2013. Of 368 total patients, 59 were randomly selected and analyzed for their age, gender, presentation, imaging, follow-up, treatment, and outcomes. Among imaged patients, the study indication was compared to the ACR Appropriateness Criteria with the indication deemed appropriate based on a rating of 5 or higher.

Of the 59 patient subgroup, the average age was 49 years (51% F, 49% M). The majority presented with acute or acute on chronic LBP (54 patients, 92%) and had a precipitating event (30 patients, 51%), 18 (31%) underwent imaging in the ED (11 with MRI, 2 CT, 3 plain films, 1 MRI & plain film, and 1 CT & plain film), and 11 (19%) had outpatient imaging (5 with MRI, 3 CT, and 3 plain films). 34/59 patients (58%) had neither ED nor outpatient imaging. The majority were appropriately imaged based on the ACR Appropriatness Criteria, 17/18, 93% for pts imaged in the ED and 11/11, 100% imaged as outpatients. Of the ED patients, imaging variants included 5/17 trauma and/or osteoporosis, 4/17 for neuro deficit, 4/17 for prior spinal pathology, 4/17 infection or cancer. 44 patients (76%) had outpatient or ER follow-up after discharge: of these, 23 (52%) had resolution or return of pain to baseline with pain medication and PT, 7 (16%) had improvement with intervention (ESI or kyphoplasty), 7 (16%) improved with surgery, and 5 patients had persistent pain (11%). Of the 7 patients who ultimately had surgery, 4 had prior ED or outpatient imaging, and 2 had imaging prior to the initial ED visit.

The majority of our ED subgroup with LBP did not undergo imaging. Those who did so were imaged based on appropriate ACR guidelines and most had improvement or resolution of their LBP with conservative management.

Adequate imaging utilization for LBP is a key cost effectiveness tool.

Rao, S, Rao, S, Avery, L, Abujudeh, H, Saini, S, Prabhakar, A, Low Back Pain in the ER—Imaging and Outcomes.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045532.html