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January 1989

Selective Criteria May Increase Lumbosacral Spine Roentgenogram Use in Acute Low-Back Pain

Author Affiliations

From the Division of General Internal Medicine, Duke University Medical Center, Durham, NC (Dr Frazier); the Division of General Medicine and Clinical Epidemiology (Dr Carey), the School of Education (Mr Khayrallah), and the Office of Research and Development for Education in the Health Professions (Dr McGaghie), University of North Carolina at Chapel Hill; and the Division of Geriatrics, Bowman Gray School of Medicine, Winston-Salem, NC (Dr Lyles). Dr Frazier is now with the Division of Occupational Medicine, Duke University Medical Center, Durham, NC.

Arch Intern Med. 1989;149(1):47-50. doi:10.1001/archinte.1989.00390010065005

• Eleven clinical criteria have been proposed to limit use of lumbosacral spine roentgenograms in patients with acute low-back pain who are at risk for vertebral cancer, osteomyelitis, acute fracture, or herniated disk. We retrospectively applied the criteria to 471 patients with acute low-back pain in three teaching hospital walk-in clinics. Roentgenograms were obtained at the initial visit in 99 patients (21.1%); the number would have increased to 217 (46.1%) if the criteria had been used. The following four patient characteristics were associated with actual roentgenogram use: older age, longer duration of symptoms, reflex asymmetry, and point vertebral tenderness. Adoption of the 11 criteria studied herein may inadvertently increase roentgenogram use, thereby raising health care costs and exposing more patients to gonadal irradiation. The standard of practice in these three clinics seemed to entail use of less broad roentgenogram selection criteria. Other published guidelines for roentgenograms emphasize clinical follow-up, reserving further evaluation for patients who fail to improve after a trial of bed rest and analgesics.

(Arch Intern Med 1989;149:47-50)

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