{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T18:08:35Z","timestamp":1783102115201,"version":"3.54.6"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T00:00:00Z","timestamp":1735948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1194483"],"award-info":[{"award-number":["APP1194483"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The Australian Rheumatology Association identified the use of imaging in patients with low back pain without indication of serious pathology as a low\u2010value practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To determine the appropriateness of diagnostic lumbar spine imaging requests in patients with low back pain presenting to a Western Australian hospital's emergency department.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective review of all adult patients (18\u2009years and older) who presented with low back pain to the Fiona Stanley Hospital emergency department from 1 July 2020 to 31 December 2020. The appropriateness of the imaging requests was judged using the American College of Radiology's Appropriateness Criteria. The number and proportion of appropriate and inappropriate lumbar spine imaging requests were reported overall and by imaging modality together with reasons for the judgements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1459 patients were included. Three hundred eight patients (21.1%) received lumbar spine imaging requests, with 350 diagnostic imaging requests eligible for analysis. Two hundred eighty (80.0%) imaging requests were judged to be appropriate (194\/253 (76.7%) plain radiographs, 57\/66 (86.4%) computed tomography, 29\/31 (93.5%) magnetic resonance imaging). The most common reasons for an appropriate imaging request were suspected vertebral fracture (<jats:italic>n<\/jats:italic> =\u2009223, 79.6%), followed by malignancy (<jats:italic>n<\/jats:italic> =\u200926, 9.3%). Of the 70 inappropriate imaging requests, 62 (88.6%) requests occurred in the absence of alerting features and eight (11.4%) requests were the wrong choice of modality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Four in five lumbar spine imaging requests for investigating low back pain were appropriate. Of the inappropriate requests, the most common reason was the absence of alerting features, while a small number were the incorrect imaging modality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.16626","type":"journal-article","created":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T20:19:26Z","timestamp":1736021966000},"page":"573-580","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Appropriateness of lumbar spine imaging in patients presenting to the emergency department with low back pain in a Western Australian tertiary hospital"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1750-590X","authenticated-orcid":false,"given":"Aaron W. K.","family":"Mau","sequence":"first","affiliation":[{"name":"Department of Rheumatology Fiona Stanley Hospital  Perth Western Australia Australia"},{"name":"Medical School University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen I.","family":"Keen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Fiona Stanley Hospital  Perth Western Australia Australia"},{"name":"Medical School University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8289-4922","authenticated-orcid":false,"given":"Catherine L.","family":"Hill","sequence":"additional","affiliation":[{"name":"Rheumatology Unit The Queen Elizabeth Hospital  Adelaide South Australia Australia"},{"name":"Discipline of Medicine University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0597-0933","authenticated-orcid":false,"given":"Rachelle","family":"Buchbinder","sequence":"additional","affiliation":[{"name":"Preventive Medicine Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001869"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-022-08134-8"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.31128\/AJGP-03-18-4525"},{"key":"#cr-split#-e_1_2_6_5_1.1","unstructured":"Australian Institute of Health and Welfare.Disease Expenditure in Australia 2018-19. Canberra: Australian Institute of Health and Welfare[updated 2021 Aug 15"},{"key":"#cr-split#-e_1_2_6_5_1.2","unstructured":"cited 2022 May 14]. Available from URL:https:\/\/www.aihw.gov.au\/reports\/health-welfare-expenditure\/disease-expenditure-australia\/contents\/about"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2019-009383"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnab260"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2021.08.002"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2021.08.003"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1463423620000626"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-100087"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.13654"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60172-0"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-019-05918-1"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2022.100459"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.13279"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzab103"},{"key":"#cr-split#-e_1_2_6_18_1.1","unstructured":"Australian Institute of Health and Welfare.Fiona Stanley Hospital: emergency department care activity. Canberra: Australian Institute of Health and Welfare[updated 2021 Sep 2"},{"key":"#cr-split#-e_1_2_6_18_1.2","unstructured":"cited 2023 Jun 8]. Available from URL:https:\/\/www.aihw.gov.au\/reports-data\/myhospitals\/hospital\/h0746"},{"key":"e_1_2_6_19_1","unstructured":"South Metropolitan Health Service Fiona Stanley Hospital.About us. Perth: Government of Western Australia[cited 2023 Jun 8]. Available from URL:https:\/\/www.fionastanley.health.wa.gov.au\/About-us"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f7095"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2022-212718"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000004170"},{"key":"e_1_2_6_24_1","first-page":"875","article-title":"Spondylodiscitis: diagnosis and treatment options: a systematic review","volume":"114","author":"Herren C","year":"2017","journal-title":"Dtsch Arztebl Int"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.16626","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T10:17:18Z","timestamp":1746872238000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.16626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,4]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1111\/imj.16626"],"URL":"https:\/\/doi.org\/10.1111\/imj.16626","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,4]]},"assertion":[{"value":"2024-08-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}