Mohammadi Navid, Farahmand Ferial, Hadizadeh Kharazi Homayoun, Mojdehipanah Hossein, Karampour Hossein, Nojomi Marzieh
Associate Professor, Department of Community Medicine, Qazvin University of Medical Sciences, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
Community Medicine Specialist, Department of Community Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Med J Islam Repub Iran. 2016 Sep 17;30:415. eCollection 2016.
Back pain is a common patients' complaint, and its etiology is important because of different potential treatment approaches (based on causes). For a better diagnosis, magnetic resonance imaging (MRI) is widely used in clinical settings that may result in inappropriate requests. This study aims to evaluate the appropriateness of the lumbosacral MRI requests in patients with back pain in two public/referral and private imaging centers in Tehran. In this cross-sectional study, 279 patients from both centers were recruited in 2014. A checklist was developed based on the internationally recognized clinical guidelines (NICE, and AHRQ) for determining the indications. An expert panel of related specialties finalized them. Patients' demographic and some anthropometric measures, as well as MRI reports, were collected. The mean±SD age of patients was 47.9±14.78 years with a dominance of females (M/F=38.4/61.6). About 77% (n=214) of lumbosacral MRIs were requested in accordance with the guidelines. Indicated MRI requests were significantly higher in the private imaging center (p=0.019, OR=2.087, CI 95%: 1.13-3.85). In the private center, 80.6% and in the public center, 70.4% of the MRI requests were in accordance with the guidelines. The proportion of non-indicated MRI requests based on the valid guidelines is about ¼ of all requests that is compatible with some other studies mostly from developed countries.
背痛是患者常见的主诉，由于潜在的治疗方法不同（基于病因），其病因很重要。为了更好地诊断，磁共振成像（MRI）在临床环境中被广泛使用，这可能导致不恰当的检查申请。本研究旨在评估德黑兰两家公立/转诊和私立影像中心中背痛患者腰骶部MRI检查申请的合理性。在这项横断面研究中，2014年从两家中心招募了279名患者。根据国际认可的临床指南（英国国家卫生与临床优化研究所和美国医疗保健研究与质量局）制定了一份清单以确定适应症。相关专业的专家小组最终确定了这些清单。收集了患者的人口统计学和一些人体测量数据以及MRI报告。患者的平均年龄±标准差为47.9±14.78岁，女性占主导（男/女=38.4/61.6）。约77%（n=214）的腰骶部MRI检查申请符合指南要求。私立影像中心的MRI检查申请符合指征的比例显著更高（p=0.019，OR=2.087，95%置信区间：1.13 - 3.85）。在私立中心，80.6%的MRI检查申请符合指南要求，在公立中心这一比例为70.4%。基于有效指南，非指征性MRI检查申请的比例约占所有申请的四分之一，这与其他一些主要来自发达国家的研究结果相符。
