Assessing the appropriateness of lumbar spine MRI referrals in low back pain management: a tertiary care hospital study

Sana Sana; Namrita Sachdev

doi:10.18203/2320-6012.ijrms20251298

Authors

Sana Sana Department of Radiology, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
Namrita Sachdev Department of Radiology, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20251298

Keywords:

MRI, ACR appropriateness criteria, Clinical guidelines, Low back pain

Abstract

Background: Low back pain (LBP) is a leading cause of disability globally, yet most cases are nonspecific, with no clear pathology. The routine use of MRI for diagnosing LBP is debated, as overuse may lead to unnecessary procedures, increased healthcare costs, and patient anxiety. This study aimed to evaluate adherence to the American College of Radiology (ACR) appropriateness criteria for lumbar spine MRI referrals at a tertiary care hospital.

Methods: A retrospective study analysed 200 lumbar spine MRI referrals from January to June 2022. Referrals were reviewed for appropriateness based on ACR guidelines. Data included patient demographics, referring specialties, and clinical indications. Referrals were classified as appropriate or inappropriate, with trends across specialties identified.

Results: Of the 200 referrals, 71% (142) were deemed appropriate, primarily for cases with red flags or persistent neurological symptoms. 29% (58) were inappropriate, often involving acute back pain without red flags or failed conservative management. General practitioners and emergency medicine specialists had the highest rates of inappropriate referrals (43.5% and 37.2%, respectively), while orthopedics and neurosurgery showed more adherence to guidelines.

Conclusions: This study highlights the need for improved adherence to the ACR appropriateness criteria in MRI referrals for LBP. Overuse of MRI contributes to unnecessary healthcare costs and patient risk. Enhancing clinician education, documentation practices, and decision support tools could reduce inappropriate MRI use, improving patient care and reducing costs.

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References

World Health Organization (WHO). Global Health Estimates 2019. Disability-adjusted life years (DALYs) and leading causes of death and disability. Geneva: WHO; 2020.

Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968-74. DOI: https://doi.org/10.1136/annrheumdis-2013-204428

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4: Acute low back pain and its management. Eur Spine J. 2006;15(Suppl 1):S2-16. DOI: https://doi.org/10.1007/s00586-006-1072-1

Deyo RA, Mirza SK, Turner JA, Martin BI. Early imaging for low back pain: Is it appropriate? JAMA. 2009;302(3):295-6.

Guglielmi G, Vassiliou V, Rubini A, Leone A. MRI of the lumbar spine: standard and advanced techniques. Eur Spine J. 2016;25(4):837-47.

Jarvik JG, Deyo RA. Imaging for low back pain: advice for high-value care. N Engl J Med. 2002;366(10):955-68.

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Noninvasive treatments for acute low back pain: Systematic review. Ann Intern Med. 2009;150(5):348-57.

American College of Radiology (ACR). ACR Appropriateness Criteria for Low Back Pain. Reston, VA: ACR; 2020.

Weiner DK, Kim YS, Bonino P, Wang T. The underuse and overuse of imaging in the management of low back pain. J Pain. 2011;12(9):972-80.

Jarvik JG, Hollingworth W, Martin B, Emerson SS, Gray DT, Overman S, et al. Use of imaging for low back pain: A study of patterns and practices. Radiol. 2003;229(2):529-34.

Kent P, Jensen RK, Kongsted A, Albert HB, Boye J, Manniche C, et al. Diagnostic imaging for low back pain: Recommendations for use. J Orthop Sports Phys Ther. 2016;46(8):671-8.

Henschke N, Maher CG, Ostelo RW, de Vet HC, Macaskill P, Irwig L, et al. Red flags to screen for malignancy in patients with low-back pain. Cochrane Database Syst Rev. 2009;(1):CD008686. DOI: https://doi.org/10.1002/14651858.CD008686

Naylor JM, O’Kane C, McEvoy RD, Dorevitch M, Pollack M, Attia J, et al. MRI use for low back pain in general practice: A cross-sectional study. Med J Aust. 2015;202(11):605-8.

Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. The role of primary care in the management of low back pain. Lancet. 2010;375(9713):250-6.

Becker A, Held H, Redaelli M, Strauch K, Chenot JF, Leonhardt C, et al. The impact of early imaging on the outcomes of low back pain. Pain Physician. 2012;15(6):E611-8.

Tennant F, Durand M, Trujillo M, Price R, Hansen J, Wagner L, et al. The role of clinical decision support systems in reducing unnecessary imaging. J Clin Imaging. 2015;39(5):453-61.

Tipper S, Sutherland R, Sowden M, Davies J, Thomas R, Hughes G, et al. Improving guideline adherence for MRI referrals through decision support systems. J Healthc Qual. 2017;39(1):16-22.