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How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years
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Downie, Aron, Hancock, Mark, Jenkins, Hazel, Buchbinder, Rachelle, Harris, Ian, Underwood, Martin, Goergen, Stacy and Maher, Chris G. (2020) How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years. British Journal of Sports Medicine, 54 (11). pp. 642-651. doi:10.1136/bjsports-2018-100087 ISSN 0306-3674.
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Official URL: http://doi.org/10.1136/bjsports-2018-100087
Abstract
Objectives
To estimate the proportion of patients seeking care for low back pain (LBP) who are imaged and explore trends in the proportion of patients who received diagnostic imaging over time. We also examined the effect of study-level factors on estimates of imaging proportion.
Data sources
Electronic searches of MEDLINE, Embase and CINAHL databases from January 1995 to December 2017.
Eligibility criteria for selecting studies
Observational designs and controlled trials that reported imaging for patients presenting to primary care or emergency care for LBP. We assessed study quality and calculated pooled proportions by care setting and imaging type, with strength of evidence assessed using the GRADE system.
Results
45 studies were included. They represented 19 451 749 consultations for LBP that had resulted in 4 343 919 imaging requests/events over 21 years. Primary care: moderate quality evidence that simple imaging proportion was 16.3% (95% CI 12.6% to 21.1%) and complex imaging was 9.2% (95% CI 6.2% to 13.5%). For any imaging, the pooled proportion was 24.8% (95% CI 19.3%to 31.1%). Emergency care: moderate quality evidence that simple imaging proportion was 26.1% (95% CI 18.2% to 35.8%) and high-quality evidence that complex imaging proportion was 8.2% (95% CI 4.4% to 15.6%). For any imaging, the pooled proportion was 35.6% (95% CI 29.8% to 41.8%). Complex imaging increased from 7.4% (95% CI 5.7% to 9.6%) for imaging requested in 1995 to 11.4% (95% CI 9.6% to 13.5%) in 2015 (relative increase of 53.5%). Between-study variability in imaging proportions was only partially explained by study-level characteristics; there were insufficient data to comment on some prespecified study-level factors.
Summary/conclusion
One in four patients who presented to primary care with LBP received imaging as did one in three who presented to the emergency department. The rate of complex imaging appears to have increased over 21 years despite guideline advice and education campaigns.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RD Surgery | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Backache -- Diagnosis, Back -- Diseases -- Diagnosis | ||||||||
Journal or Publication Title: | British Journal of Sports Medicine | ||||||||
Publisher: | B M J Group | ||||||||
ISSN: | 0306-3674 | ||||||||
Official Date: | 15 May 2020 | ||||||||
Dates: |
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Volume: | 54 | ||||||||
Number: | 11 | ||||||||
Page Range: | pp. 642-651 | ||||||||
DOI: | 10.1136/bjsports-2018-100087 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Reuse Statement (publisher, data, author rights): | Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Copyright Holders: | Author(s) (or their employer(s)) 2019 | ||||||||
Date of first compliant deposit: | 25 February 2019 | ||||||||
Date of first compliant Open Access: | 25 February 2019 |
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