Abstract
BackgroundKnee pain is the commonest pain complaint amongst older adults in general practice. General Practitioners (GPs) may use x rays when managing knee pain, but little information exists regarding this process. Our objectives, therefore, were to describe the information GPs provide when ordering knee radiographs in older people, to assess the association between a clinical diagnosis of osteoarthritis (OA) and the presence of radiographic knee OA, and to investigate the clinical content of the corresponding radiologists' report.MethodsA cross sectional study of GP requests for knee radiographs and their matched radiologists' reports from a local radiology department. Cases, aged over 40, were identified during an 11-week period. The clinical content of the GPs' requests and radiologists' reports was analysed. Associations of radiologists' reporting of i) osteoarthritis, ii) degenerative disease and iii) individual radiographic features of OA, with patient characteristics and clinical details on the GPs' requests, were assessed.ResultsThe study identified 136 cases with x ray requests from 79 GPs and 11 reporting radiologists. OA was identified clinically in 19 (14%) of the requests, and queried in another 31 (23%). The main clinical descriptor was pain in 119 cases (88%). Radiologists' reported OA in 22% of cases, and the features of OA were mentioned in 63%. Variation in reporting existed between radiologists. The commonest description was joint space narrowing in 52 reports (38%). There was an apparent although non significant increase in the reporting of knee OA when the GP had diagnosed or queried it (OR 1.95; 95% CI 0.76, 5.00).ConclusionThe features of radiographic OA are commonly reported in those patients over 40 whom GPs send for x ray. If OA is clinically suspected, radiologists appear to be more likely to report its presence. Further research into alternative models of referral and reporting might identify a more appropriate imaging policy in knee disorders for primary care.
Highlights
Knee pain is the commonest pain complaint amongst older adults in general practice
Clinical osteoarthritis is not necessarily equivalent to radiographic disease since those aged over 45 with knee pain will have x ray changes consistent with osteoarthritis in 36–50% of cases [6,7,8,9,10], whilst between 24 – 56% of patients with radiographic knee osteoarthritis experience pain [6,11,12,13,14,15,16,17,18] We have previously investigated the influence of x rays on General Practitioners (GPs)' choice of care, and shown that, in identical clinical situations, x ray evidence of radiographic osteoarthritis altered their management of knee symptoms – even if the GP would not have chosen to x ray the knees in that situation [19]
We have carried out a study to determine the content of information provided by GPs when they request a knee x ray, whether they mention a clinical diagnosis of osteoarthritis (OA), and to estimate the association between a GP's clinical diagnosis of OA on an x ray request and the presence of radiographic knee OA on the radiologist's report
Summary
Knee pain is the commonest pain complaint amongst older adults in general practice. General Practitioners (GPs) may use x rays when managing knee pain, but little information exists regarding this process. We have carried out a study to determine the content of information provided by GPs when they request a knee x ray, whether they mention a clinical diagnosis of osteoarthritis (OA), and to estimate the association between a GP's clinical diagnosis of OA on an x ray request and the presence of radiographic knee OA on the radiologist's report. Roland and van Tulder have suggested that, when reporting x rays of the back, radiologists should use pre-set statements which indicate that the appearance of 'spinal degeneration' may not be related to the patient's symptoms [20] This is because in back pain, as with knee pain, radiographic findings do not necessarily equate with the clinical picture and, such statements might help to nullify anxiety and inappropriate restriction of activity which might arise from a diagnosis of degeneration. A further objective of our study was to investigate whether a similar problem might arise with knee x ray reports by determining the language and comments on severity contained in radiologists' reports on knee x rays
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