Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain.
Eur J Radiol. 2013 Jun;82(6):1008-14. doi: 10.1016/j.ejrad.2013.01.017. Epub 2013 Feb 16.
To determine the minimum percentage of lumbar spine magnetic resonance imaging (LSMRI) which are inappropriately prescribed in routine practice.
LSMRI performed prospectively on 602 patients in 12 Radiology Services across 6 regions in Spain, were classified as "appropriate", "uncertain" or "inappropriate" based on the indication criteria established by the National Institute for Clinical Excellence, the American College of Physicians and Radiology, and current evidence-based clinical guidelines. Studies on patients reporting at least one "red flag" were classified as "appropriate". A logistic regression model was developed to identify factors associated with a higher likelihood of inappropriate LSMRI, including gender, reporting of referred pain, health care setting (private/public), and specialty of prescribing physician. Before performing the LSMRI, the radiologists also assessed the appropriateness of the prescription.
Eighty-eight percent of LSMRI were appropriate, 1.3% uncertain and 10.6% inappropriate. The agreement of radiologists' assessment with this classification was substantial (k=0.62). The odds that LSMRI prescriptions were inappropriate were higher for patients without referred pain [OR (CI 95%): 13.75 (6.72; 28.16)], seen in private practice [2.25 (1.20; 4.22)], by orthopedic surgeons, neurosurgeons or primary care physicians [2.50 (1.15; 5.56)].
Efficiency of LSMRI could be improved in routine practice, without worsening clinical outcomes.
确定在常规实践中腰椎磁共振成像（LSMRI）被不恰当地开具的最低百分比。
在西班牙 6 个地区的 12 个放射科服务中，对 602 名患者前瞻性地进行了 LSMRI，根据国家临床卓越研究所、美国医师学院和基于当前证据的临床指南制定的适应症标准，将其分类为“适当”、“不确定”或“不适当”。对报告至少一个“红旗”症状的患者进行的研究被归类为“适当”。建立了一个逻辑回归模型，以确定与更高可能性的不适当 LSMRI 相关的因素，包括性别、报告的转诊疼痛、医疗保健环境（私人/公共）和处方医生的专业。在进行 LSMRI 之前，放射科医生还评估了处方的适当性。
88%的 LSMRI 是适当的，1.3%是不确定的，10.6%是不适当的。放射科医生评估与这种分类的一致性很高（k=0.62）。对于没有转诊疼痛的患者（OR（95%CI）：13.75（6.72；28.16））、在私人诊所就诊的患者（2.25（1.20；4.22））、骨科医生、神经外科医生或初级保健医生开具的 LSMRI 处方更有可能不适当（2.50（1.15；5.56））。
在常规实践中，可以提高 LSMRI 的效率，而不会降低临床结果。
