Deyo R A, Diehl A K
J Gen Intern Med. 1986 Jan-Feb;1(1):20-5. doi: 10.1007/BF02596320.
Low back pain (LBP) often prompts radiography, although the diagnostic yield of lumbar spine films is low, and many radiographic abnormalities are unrelated to symptoms. Criteria have been proposed for selective x-ray use, but their value and safety are uncertain. To evaluate these criteria, the authors prospectively studied 621 walk-in patients with LBP. The yield of explanatory x-ray findings was over three times greater among patients with indications for radiography than among those without. Furthermore, an indication for x-rays existed for all patients found to have a malignancy, and for 13 of 14 patients with an identified fracture. Actual physician ordering, however, did not correspond well with the recommended indications. Application of selective criteria appears safe and may improve the yield of useful findings. It may not, however, reduce x-ray utilization from current levels without further refinement in the criteria.
下背痛（LBP）常促使进行放射检查，尽管腰椎X光片的诊断率较低，且许多影像学异常与症状无关。已有关于选择性使用X光的标准被提出，但其价值和安全性尚不确定。为评估这些标准，作者对621名因下背痛前来就诊的患者进行了前瞻性研究。有放射检查指征的患者中，可解释的X光检查结果的发生率比无指征患者高出三倍多。此外，所有被发现患有恶性肿瘤的患者以及14名已确诊骨折患者中的13名均有进行X光检查的指征。然而，实际医生的开单情况与推荐指征并不十分相符。应用选择性标准似乎是安全的，且可能提高有用检查结果的发生率。然而，如果不进一步完善标准，可能无法将X光的使用量从当前水平降低。
