Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104.
Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
AJR Am J Roentgenol. 2020 Feb;214(2):395-399. doi: 10.2214/AJR.19.21674. Epub 2019 Nov 19.
Back pain is one of the most common reasons for adult patients 18-65 years old to seek emergency care. Use of imaging for patients without so-called red flags (trauma, malignancy, or infection) may result in potentially unnecessary costs and radiation exposure. The aim of this study was to investigate the use of imaging for patients with emergency visits for low back pain. Emergency department visits for patients with low back pain billed to insurance were identified by querying a national commercial claims and encounters database for patients 18-64 years old. Patients with concomitant encounter diagnoses suggestive of trauma or those with prior visits for back pain were excluded. Imaging modalities (radiography, CT, and MRI) were identified by Current Procedural Terminology codes. A total of 134,624 encounters met inclusion criteria. Imaging was obtained in 44,405 (33.7%) visits and decreased from 34.4% to 31.9% between 2011 and 2016 (odds ratio per year, 0.98 [95% CI, 0.98-0.99]; < 0.001). During the study period, 30.9% of patients underwent radiography, 2.7% of patients underwent CT, and 0.8% of patients underwent MRI for evaluation of low back pain. The use of imaging varied significantly by geographic region ( < 0.001), with patients in the southern United States undergoing 10% more imaging than patients in the western United States. The use of imaging for the initial evaluation of patients with low back pain in the emergency department continues to occur at a high rate, in approximately one in three new emergency visits for low back pain in the United States.
背痛是 18-65 岁成年患者寻求急诊治疗的最常见原因之一。对于没有所谓“红旗”（外伤、恶性肿瘤或感染）的患者，使用影像学检查可能会导致潜在的不必要的费用和辐射暴露。本研究旨在调查急诊科因腰痛就诊的患者使用影像学检查的情况。通过查询全国商业索赔和就诊数据库，确定了 18-64 岁有保险的腰痛患者的急诊就诊。排除了同时存在外伤或既往腰痛就诊提示的患者。通过当前程序术语代码识别影像学方式（X 线摄影、CT 和 MRI）。共有 134624 次就诊符合纳入标准。44405 次就诊（33.7%）获得了影像学检查，2011 年至 2016 年间，这一比例从 34.4%降至 31.9%（每年的比值比，0.98 [95%CI，0.98-0.99]；<0.001）。在研究期间，30.9%的患者接受 X 线摄影检查，2.7%的患者接受 CT 检查，0.8%的患者接受 MRI 检查用于评估腰痛。影像学检查的使用在地理位置上差异显著（<0.001），美国南部地区的患者比美国西部地区的患者多进行 10%的影像学检查。在美国，大约每三个新的急诊腰痛就诊中，就有一个继续以高比例对患者进行初始影像学评估。
