Efforts to curtail unnecessary back-pain imaging coming up short
Imaging rates for lower back pain in the emergency department remain constant, despite efforts to curtail such healthcare waste, according to new research.
About 1 in every 20 ED visits is for low back pain, making it one of the most common concerns seen in this setting. Outpatient opioid describing for low back pain fell between 2016 and 2022, responding to quality improvement efforts. At the same time, the rate of patients receiving plain X-rays stayed static, at 36.6% in 2016, increasing slightly to 36.9% by 2022, experts wrote in the Annals of Emergency Medicine.
Meanwhile, the rate of ED patients receiving CT for low back pain increased from 3.9% to 7% over seven years, while MRI climbed from 2.4% to 6.5%.
“These findings have no direct clinical impact but suggest that further interventions may be required to reduce inappropriate imaging,” wrote Anuva Fellner, MPH, and Howard S. Kim, MD, MS, with the Northwestern University Feinberg School of Medicine in Chicago.
For the study, researchers analyzed a nationally representative sample from the CDC’s National Hospital Ambulatory Medical Care Survey. They pinpointed ED visits with a back-pain-related reason and used the NHAMC sampling weights to produce nationwide estimates of imaging use. Almost 40% of all U.S. adults report experiencing some degree of low back pain over the last three months, previous studies have found. But patient outcomes following an ED visit remain poor, with healthcare expenditures increasing over the last 20 years, driven partly by wasteful imaging that provides no clinical benefit.
“Thus, improving emergency care for low back pain has been a critical focus of both quality improvement and research efforts in the U.S. and globally,” Fellner and Kim noted.
During the study period, there were an estimated 52.8 million ED visits for low back pain in the U.S. Patients were an average of about 45 years old, 60% women, over 46% non-Hispanic white, and 31% on Medicaid. Altogether, low back pain accounted for about 5.3% of all ED visits. Average pain score was 7.2 out of 10, and nearly 14% of such visitors arrived by ambulance, while 40% were related to injury or trauma. (Currently, the Choosing Wisely guidelines mention trauma as an acceptable indication for back imaging, the authors noted.)
As of 2016, opioids were administered in 35% of ED cases and prescribed in 32.5%. By 2022, these figures had fallen to 24.5% and 13.5%, respectively. Meanwhile, X-rays were obtained in about 39.4% of all ED visits across the seven-year study period. Researchers observed higher rates of radiographs and opioid prescribing among patients 75 and older. Across the entire study period, about 5.4% of patients received CT and 3.2% MRI.
“These findings serve as important contemporary benchmarks for quality improvement and research efforts focused on improving patient outcomes and reducing low-value emergency care for low back pain,” the authors wrote.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.