Abstract
According to international guidelines, radiological examinations of the lumbar spine are of limited value and do not improve clinical outcome unless there are clinical red flags present suggesting serious pathology. Nevertheless, the utilization of lumbar spine imaging remains high. To follow up the effects of active referral guideline implementation and education on the number and appropriateness of lumbar spine radiographs and computed tomography (CT) examinations in young patients and to evaluate whether the appropriate radiographs have more significant findings. Referral guidelines for spine examinations and info pocket cards on radiation protection were distributed to referring practitioners. Educational lectures were provided annually. The number of lumbar spine radiographs and CT examinations on patients aged <35 years was analyzed before and three years after the interventions. Appropriateness and findings of 313 radiographs and appropriateness of 117 CT scans of the lumbar spine were assessed. The number of lumbar spine radiographs and CT scans decreased significantly after the interventions and the level remained unchanged during the follow-up (-33% and -72%, respectively, P < 0.001). Appropriateness improved significantly in radiographs from 2005 to 2009 (65% vs. 85%) and in CT scans already from 2005 to 2007 (23% vs. 63%). Radiographs that were in accordance with the guidelines had more significant findings compared to radiographs that were not; in young adults, this was 56% versus 21% (P < 0.001). A combination of interventions can achieve a sustained reduction in the number of lumbar spine examinations and improve appropriateness. Inappropriate lumbar spine radiographs do not seem to contain significant findings that would affect patient care.
Highlights
In the Global Burden of Disease Study, low back and neck pain was the fourth leading cause of disabilityadjusted life years (DALY) [1]
A combination of interventions, guideline implementation, and education decreased the number of lumbar spine radiographs and computed tomography (CT) scans in young patients, and the result persisted after three years of follow-up
The interventions resulted in more appropriate examinations than before. It appears that the appropriate radiographs had more significant findings than the inappropriate ones
Summary
In the Global Burden of Disease Study, low back and neck pain was the fourth leading cause of disabilityadjusted life years (DALY) [1]. The radiation dose of lumbar spine radiography is among the highest for conventional radiographs and that of lumbar spine CT is about six times higher. In these examinations, radiation is delivered to radiation-sensitive organs [5,7]. Purpose: To follow up the effects of active referral guideline implementation and education on the number and appropriateness of lumbar spine radiographs and computed tomography (CT) examinations in young patients and to evaluate whether the appropriate radiographs have more significant findings. Results: The number of lumbar spine radiographs and CT scans decreased significantly after the interventions and the level remained unchanged during the follow-up (À33% and À72%, respectively, P < 0.001). Inappropriate lumbar spine radiographs do not seem to contain significant findings that would affect patient care
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