The demand for diagnostic imaging continues to rise. Against the backdrop of rising healthcare costs and finite resources, this has prompted a paradigm shift towards value-driven patient care. Inappropriate imaging is a barrier towards achieving this goal, which runs counter to prevailing evidence-based guidelines and contributes to rising healthcare costs. Our objective was to evaluate the appropriateness of lumbar spine X-rays in a tertiary referral emergency department and assess whether physician specialization and years of experience influence appropriateness.
Retrospective review of 1030 lumbar spine radiographs performed in an emergency department of an academic medical centre over a consecutive 3-month period. Referral indications were reviewed for adherence to 2021 American College of Radiology (ACR) appropriateness guidelines for low back pain, and referral pattern evaluated among physician groups based on specialist training and years in practice.
63.8% of lumbar spine radiograph were appropriate, with trauma being the most common indication. 36.2% orders were inappropriate, with low back pain of less than 6 weeks duration being the most common indication. Significant differences in inappropriate orders was found (p<0.001) across physician groups: qualified Emergency Medicine specialists (20.9% inappropriate orders), specialists in-training (27.8%) and non-specialists with ≥3 (60.0%) and <3 (36.9%) years in practice, respectively.
Approximately a third of lumbar spine radiography performed in the emergency room were inappropriately ordered by ACR guidelines; specialist training and years in practice affected referral patterns. Integrating evidence-based appropriateness guidelines into the physician order workflow and targeting older non-specialists may promote more judicious imaging and reduce healthcare costs.