{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T19:57:45Z","timestamp":1780343865002,"version":"3.54.1"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,8,13]],"date-time":"2023-08-13T00:00:00Z","timestamp":1691884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Chronic neck pain is a common reason for doctor visits in the United States. This diagnosis can be evaluated through patient history, physical examination, and judicious use of radiographs. However, possible inappropriate magnetic resonance imaging (MRI) ordering persists. We hypothesized that no difference in ordering practices, ordering appropriateness, and subsequent intervention would be appreciated regarding physician specialty, location, patient characteristics, and history and physical exam findings. A multisite retrospective review of cervical spine MRI\u00a0between 2014 and 2018 was performed. A total of 332 patients were included. Statistical analysis was used to assess MRI order appropriateness, detail of history and physical exam findings, and intervention decision\u2010making among different specialties. If significant differences were found, multiple linear regression was performed to evaluate the association of MRI order appropriateness regarding physician specialty, location, patient characteristics and history, and physical exam findings. The significance level for all tests was set at &lt;0.05 Orthopedic surgeons ordered MRIs most appropriately with an average American College of Radiology\u00a0(ACR) score of 8.4 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.005). Orthopedic surgeons had more comprehensive physical exams as compared to the remaining specialties. The decision for intervention did not vary by physician specialty or ACR score, except for patients of pain medicine physicians who received pain management (<jats:italic>p<\/jats:italic>\u2009=\u20090.000). Orthopedic surgeons utilize MRI most appropriately and have more comprehensive physical exams. These findings suggest a need for increased physician education on what indicates an appropriate MRI order to improve the use of resources and further protect patient risk\u2010benefit profiles. Further research elucidating factors to minimize negative findings in \u201cappropriate\u201d MRIs is indicated.\u00a0Clinical significance:\u00a0More detailed physical exams may lead to more appropriately ordered MRIs, subsequently resulting in surgery or procedures being performed when appropriately indicated. This suggests the need for increased physician education on when MRI ordering is appropriate for chronic neck pain to improve the use of resources and further protect patient risk\u2010benefit profiles.<\/jats:p>","DOI":"10.1002\/jor.25669","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T06:40:00Z","timestamp":1690872000000},"page":"425-433","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["MRI order appropriateness for chronic neck pain: Comparison of ordering practices and treatment outcomes for primary care physicians and specialists"],"prefix":"10.1002","volume":"42","author":[{"given":"Andrew","family":"Romero","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery University of Central Florida\/HCA Healthcare GME Consortium Ocala Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1486-178X","authenticated-orcid":false,"given":"Daniel","family":"Lynch","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Central Florida\/HCA Healthcare GME Consortium Ocala Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Tennessee\u2014Campbell Clinic Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Central Florida College of Medicine Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kirkpatrick","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Orlando VA Healthcare System Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004242"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20140124-16"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2013.01.017"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2013.12.015"},{"issue":"8","key":"e_1_2_8_6_1","first-page":"1029","article-title":"The extent of inappropriate use of magnetic resonance imaging in low back pain and its contributory factors","volume":"5","author":"Jame SZ","year":"2014","journal-title":"Int J Prev Med"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2016.04.013"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-199408000-00006"},{"issue":"2","key":"e_1_2_8_9_1","first-page":"68","article-title":"Inappropriate ordering of lumbar spine magnetic resonance imaging: are providers Choosing Wisely?","volume":"22","author":"Gidwani R","year":"2016","journal-title":"Am J Manag Care"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A4076"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.299.6.656"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(98)00058-X"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31816445be"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2004.09.004"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000143025.84471.79"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-004-0864-4"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.3171\/2013.8.SPINE12925"},{"issue":"5","key":"e_1_2_8_18_1","first-page":"1258","article-title":"MRI is unnecessary to clear the cervical spine in obtunded\/comatose trauma patients: the four\u2010year experience of a level I trauma center","volume":"64","author":"Tomycz ND","year":"2008","journal-title":"J\u00a0Trauma"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20150902-02"},{"key":"e_1_2_8_20_1","unstructured":"American College of Radiology.ACR Appropriateness Criteria\u00ae. 2013. 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