To the Editor.
—Dr Suarez-Almazor and colleagues1 note the potential for the Agency for Health Care Policy and Research (AHCPR) guideline recommendations for the diagnosis of low back pain to increase the use of lumbar radiographs for patients with "red flags" for fracture, tumors, or infections and suggest that a more restricted and cost-efficient set of guidelines should be proposed. As a large health insurance company with 6 million subscribers, we have chosen to use the AHCPR guideline recommendations to reduce the use of lumbar rediographs and other diagnostic imaging studies (magnetic resonance imaging and computed tomographic scans) of the lumbar region for the evaluation and management of patients with acute low back pain who do not exhibit red flags.We use the guidelines to educate our health care professionals about appropriate and cost-effective medical treatment. As with any recommendations, we do not expect strict adherence to the guideline
Gutierrez B, Bloschichak A, Kurlantzick V. Clinical Guidelines for Lumbar Radiographs for Patients With Low Back Pain. JAMA. 1997;278(21):1741-1742. doi:10.1001/jama.1997.03550210039028