{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T18:08:30Z","timestamp":1783102110865,"version":"3.54.6"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1113532"],"award-info":[{"award-number":["APP1113532"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Imaging for low back pain is widely regarded as a target for efforts to reduce low-value care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We aimed to estimate the prevalence of the overuse and underuse of lumbar imaging in patients presenting with low back pain to the emergency department (ED).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a retrospective chart review study of five public hospital EDs in Sydney, Australia, in 2019\u201320. We reviewed the clinical charts of consecutive adult patients who presented with a complaint of low back pain and extracted clinical features relevant to a decision to request lumbar imaging. We estimated the proportion of encounters where a decision to request lumbar imaging was inappropriate (overuse) or where a clinician did not request an appropriate and informative lumbar imaging test when indicated (underuse).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Six hundred and forty-nine patients presented with a complaint of low back pain, of which 158 (24.3%) were referred for imaging. Seventy-nine (12.2%) had a combination of features suggesting that lumbar imaging was indicated according to clinical guidelines. The prevalence of overuse and underuse of lumbar imaging was 8.8% (57 of 649 cases, 95% CI 6.8\u201311.2%) and 4.3% (28 of 649 cases, 95% CI 3.0\u20136.1%), respectively. Thirteen cases were classified as underuse because the patients were referred for uninformative imaging modalities (e.g. referred for radiography for suspected cauda equina syndrome).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In this study of emergency care, there was evidence of not only overuse of lumbar imaging but also underuse through failure to request lumbar imaging when indicated or referral for an uninformative imaging modality. These three issues seem more important targets for quality improvement than solely focusing on overuse.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/intqhc\/mzab103","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T11:09:22Z","timestamp":1626260962000},"source":"Crossref","is-referenced-by-count":16,"title":["Appropriateness of imaging decisions for low back pain presenting to the emergency department: a retrospective chart review study"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1646-1907","authenticated-orcid":false,"given":"Adrian C","family":"Traeger","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), PO Box M179, Missenden Road, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8544-0448","authenticated-orcid":false,"given":"Gustavo C","family":"Machado","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), PO Box M179, Missenden Road, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Bath","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), PO Box M179, Missenden Road, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Tran","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), PO Box M179, Missenden Road, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucinda","family":"Roper","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), PO Box M179, Missenden Road, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6911-7018","authenticated-orcid":false,"given":"Crystian","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), PO Box M179, Missenden Road, Sydney, NSW 2050, Australia"},{"name":"Physical Therapy Department, Faculty of Science and Technology, Sao Paulo State University, Presidente Prudente, R. Roberto S\u00edmonsen, 305 - Centro Educacional, Pres. Prudente - SP 19060-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimie","family":"Peek","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Susan Wakil Building, Western Ave, Camperdown NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Coombs","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), PO Box M179, Missenden Road, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Hall","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Memorial University, 300 Prince Philip Dr, St. John\u2019s, NL A1B 3V6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise","family":"Tcharkhedian","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Liverpool Hospital, Southwest Sydney Local Health District, Liverpool, 75 Elizabeth St, Liverpool NSW 2170, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1628-7857","authenticated-orcid":false,"given":"Chris G","family":"Maher","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), PO Box M179, Missenden Road, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,14]]},"reference":[{"key":"2022022417490984700_R1","volume-title":"Australian Hospital Statistics: Emergency Department Care 2018\u201319","author":"Australian Institute for Health and Welfare","year":"2020"},{"key":"2022022417490984700_R2","doi-asserted-by":"crossref","first-page":"E1406","DOI":"10.1097\/BRS.0b013e3181d952a5","article-title":"Diagnostic testing and treatment of low back pain in United States emergency departments: a national perspective","volume":"35","author":"Friedman","year":"2010","journal-title":"Spine (Phila Pa 1976)"},{"key":"2022022417490984700_R3","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1136\/bmjqs-2019-009383","article-title":"Management of low back pain in Australian emergency departments","volume":"28","author":"Ferreira","year":"2019","journal-title":"BMJ Qual Saf"},{"key":"2022022417490984700_R4","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.amjmed.2019.06.005","article-title":"Low back pain in the emergency department: prevalence of serious spinal pathologies and diagnostic accuracy of red flags","volume":"133","author":"Galliker","year":"2020","journal-title":"Am J Med"},{"key":"2022022417490984700_R5","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1007\/s00586-018-5673-2","article-title":"Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview","volume":"27","author":"Oliveira","year":"2018","journal-title":"Eur Spine J"},{"key":"2022022417490984700_R6","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1136\/bjsports-2018-100087","article-title":"How common is imaging for low back pain in primary and emergency care? 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