Tags

Type your tag names separated by a space and hit enter

What do we really know about the appropriateness of radiation emitting imaging for low back pain in primary and emergency care? A systematic review and meta-analysis of medical record reviews.
PLoS One. 2019; 14(12):e0225414.Plos

Abstract

BACKGROUND

Since 2000, guidelines have been consistent in recommending when diagnostic imaging for low back pain should be obtained to ensure patient safety and reduce unnecessary tests. This systematic review and meta-analysis was conducted to determine the pooled proportion of CT and x-ray imaging of the lumbar spine that were considered appropriate in primary and emergency care.

METHODS

Pubmed, CINAHL, The Cochrane Database of Systematic Reviews and Embase were searched for synonyms of "low back pain", "guidelines", and "adherence" that were published after 2000. Titles, abstracts, and full texts were reviewed for inclusion with forward and backward tracking on included studies. Included studies had data extracted and synthesized. Risk of bias was performed on all studies, and GRADE was performed on included studies that provided data on CT and x-ray separately. A random effect, single proportion meta-analysis model was used.

RESULTS

Six studies were included in the descriptive synthesis, and 5 studies included in the meta-analysis. Five of the 6 studies assessed appropriateness of x-rays; two of the six studies assessed appropriateness of CTs. The pooled estimate for appropriateness of x-rays was 43% (95% CI: 30%, 56%) and the pooled estimate for appropriateness of CTs was 54% (95% CI: 51%, 58%). Studies did not report adequate information to fulfill the RECORD checklist (reporting guidelines for research using observational data). Risk of bias was high in 4 studies, moderate in one, and low in one. GRADE for x-ray appropriateness was low-quality and for CT appropriateness was very-low-quality.

CONCLUSION

While this study determined a pooled proportion of appropriateness for both x-ray and CT imaging for low back pain, there is limited confidence in these numbers due to the downgrading of the evidence using GRADE. Further research on this topic is needed to inform our understanding of x-ray and CT appropriateness in order to improve healthcare systems and decrease patient harms.

Authors+Show Affiliations

Faculty of Medicine, Memorial University, St. John's, NL, Canada.Primary Healthcare Research Unit, Memorial University, St. John's, NL, Canada.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.Faculty of Medicine, Memorial University, St. John's, NL, Canada.Faculty of Medicine, Memorial University, St. John's, NL, Canada.Faculty of Medicine, Memorial University, St. John's, NL, Canada. Primary Healthcare Research Unit, Memorial University, St. John's, NL, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

31805073

Citation

Logan, Gabrielle S., et al. "What Do We Really Know About the Appropriateness of Radiation Emitting Imaging for Low Back Pain in Primary and Emergency Care? a Systematic Review and Meta-analysis of Medical Record Reviews." PloS One, vol. 14, no. 12, 2019, pp. e0225414.
Logan GS, Pike A, Copsey B, et al. What do we really know about the appropriateness of radiation emitting imaging for low back pain in primary and emergency care? A systematic review and meta-analysis of medical record reviews. PLoS ONE. 2019;14(12):e0225414.
Logan, G. S., Pike, A., Copsey, B., Parfrey, P., Etchegary, H., & Hall, A. (2019). What do we really know about the appropriateness of radiation emitting imaging for low back pain in primary and emergency care? A systematic review and meta-analysis of medical record reviews. PloS One, 14(12), e0225414. https://doi.org/10.1371/journal.pone.0225414
Logan GS, et al. What Do We Really Know About the Appropriateness of Radiation Emitting Imaging for Low Back Pain in Primary and Emergency Care? a Systematic Review and Meta-analysis of Medical Record Reviews. PLoS ONE. 2019;14(12):e0225414. PubMed PMID: 31805073.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What do we really know about the appropriateness of radiation emitting imaging for low back pain in primary and emergency care? A systematic review and meta-analysis of medical record reviews. AU - Logan,Gabrielle S, AU - Pike,Andrea, AU - Copsey,Bethan, AU - Parfrey,Patrick, AU - Etchegary,Holly, AU - Hall,Amanda, Y1 - 2019/12/05/ PY - 2019/06/11/received PY - 2019/11/03/accepted PY - 2019/12/6/entrez PY - 2019/12/6/pubmed PY - 2020/3/26/medline SP - e0225414 EP - e0225414 JF - PloS one JO - PLoS ONE VL - 14 IS - 12 N2 - BACKGROUND: Since 2000, guidelines have been consistent in recommending when diagnostic imaging for low back pain should be obtained to ensure patient safety and reduce unnecessary tests. This systematic review and meta-analysis was conducted to determine the pooled proportion of CT and x-ray imaging of the lumbar spine that were considered appropriate in primary and emergency care. METHODS: Pubmed, CINAHL, The Cochrane Database of Systematic Reviews and Embase were searched for synonyms of "low back pain", "guidelines", and "adherence" that were published after 2000. Titles, abstracts, and full texts were reviewed for inclusion with forward and backward tracking on included studies. Included studies had data extracted and synthesized. Risk of bias was performed on all studies, and GRADE was performed on included studies that provided data on CT and x-ray separately. A random effect, single proportion meta-analysis model was used. RESULTS: Six studies were included in the descriptive synthesis, and 5 studies included in the meta-analysis. Five of the 6 studies assessed appropriateness of x-rays; two of the six studies assessed appropriateness of CTs. The pooled estimate for appropriateness of x-rays was 43% (95% CI: 30%, 56%) and the pooled estimate for appropriateness of CTs was 54% (95% CI: 51%, 58%). Studies did not report adequate information to fulfill the RECORD checklist (reporting guidelines for research using observational data). Risk of bias was high in 4 studies, moderate in one, and low in one. GRADE for x-ray appropriateness was low-quality and for CT appropriateness was very-low-quality. CONCLUSION: While this study determined a pooled proportion of appropriateness for both x-ray and CT imaging for low back pain, there is limited confidence in these numbers due to the downgrading of the evidence using GRADE. Further research on this topic is needed to inform our understanding of x-ray and CT appropriateness in order to improve healthcare systems and decrease patient harms. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/31805073/What_do_we_really_know_about_the_appropriateness_of_radiation_emitting_imaging_for_low_back_pain_in_primary_and_emergency_care_A_systematic_review_and_meta_analysis_of_medical_record_reviews_ L2 - http://dx.plos.org/10.1371/journal.pone.0225414 DB - PRIME DP - Unbound Medicine ER -