Patricia Silveira MD, Presenter: Nothing to Disclose

Ivan Ip MD, MPH, Abstract Co-Author: Nothing to Disclose

Michael J. Healey MD, Abstract Co-Author: Nothing to Disclose

Elizabeth G. Matzkin MD, Abstract Co-Author: Nothing to Disclose

Stacy Elaine Smith MD, Abstract Co-Author: Nothing to Disclose

Ramin Khorasani MD, Abstract Co-Author: Consultant, Medicalis Corp

To examine trends in the management of outpatients with nontraumatic knee symptoms from January 2001 to December 2010.

Design: Retrospective study using nationally representative data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Setting and Participants: All adult outpatients presenting with nontraumatic knee symptoms from January 2001 to December 2010. Main Outcome Measures: Number of clinic visits, radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) utilization rates, pain medication prescription, and referral to other physician or physical therapy. Statistical analysis: Linear and logistic regressions were performed. Multiple variable regression was conducted to control for confounders.

We identified 7847 patient-visits with nontraumatic knee symptoms, which are a representative sample of an estimated 172 million outpatient visits in the United States over the study period. The average age of patients was 57.5 years; 64.3% female. The proportion of pre- and post-operative visits did not change over time. Radiograph utilization remained stable at approximately 28%, while CT and MRI utilization increased from 5% in 2001 to 8.3% in 2010 (p<0.001). Non-steroidal anti-inflammatory drugs and acetaminophen use decreased from 35.3% in 2001 to 30.6% in 2010 (p=0.001), while narcotic use increased from 5.2% to 15.2% (p<0.001). Physical therapy and other physician referral rates increased from 5.7% in 2001 to 14.1% to 2010 (p<0.001) and from 9.7% in 2001 to 15.9% to 2010 (p<0.001), respectively.

While the proportion of pre- and post-operative visits and radiograph utilization remained stable, advanced imaging increased over 60%, and referral rates to physical therapy and other physicians increased 147% and 64%, respectively. The largest increase was in narcotic use - nearly 3-fold over the decade. These findings suggest an emerging need for evidence-based guidelines regarding the use of advanced imaging and narcotic prescription for patients presenting with knee symptoms, which could reduce costs, radiation exposure, and overdose rates, and improve quality of care.

This is the first nationally representative study of ambulatory patients presenting with knee-related symptoms, the most common musculoskeletal reason for US ambulatory visits in 2009 and 2010.

Silveira, P, Ip, I, Healey, M, Matzkin, E, Smith, S, Khorasani, R, National Trends in the Management of Outpatients with Non-traumatic Knee Symptoms Over a Decade.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045599.html