The use of imaging for the initial evaluation of patients with low back pain in the emergency department (ED) continues to occur at a high rate—one in three new emergency visits are for low back pain in the United States—according to an article published ahead-of-print in the February 2020 issue of the American Journal of Roentgenology.
“Although there has been a modest decline, in 2016, approximately one in three patients still continued to receive imaging in the ED,” writes Jina Pakpoor, MD, of the University of Pennsylvania. “Further, significant geographic variation exists between differing states and regions of the United States.”
Pakpoor and colleagues identified emergency department visits for patients with low back pain billed to insurance by querying IBM’s Commercial Claims and Encounters Marketscan research database for patients 18-64 years old. Excluding patients with concomitant encounter diagnoses suggesting trauma, as well as those with previous visits for back pain, Current Procedural Terminology codes were used to identify three imaging modalities: radiography, CT, and MRI.
Of the 134,624 total encounters meeting Pakpoor’s inclusion criteria, imaging was obtained in 44,405 (33.7%) visits and decreased from 34.4% to 31.9% between 2011 and 2016 (odds ratio per year, 0.98 [95% CI, 0.98–0.99]; p p