Schwartz/Reisman Emergency Medicine Institute, Toronto, Ontario, Canada.
Schwartz/Reisman Emergency Medicine Institute, Toronto, Ontario, Canada; Sinai Health System, Toronto, Ontario, Canada.
J Emerg Med. 2020 Feb;58(2):269-274. doi: 10.1016/j.jemermed.2019.12.017. Epub 2020 Jan 27.
Choosing Wisely Canada (CWC) guidelines recommend that in the absence of clinical indicators suggestive of serious underlying pathology, physicians should not order radiological imaging for patients presenting with nonspecific low back pain (LBP).
Our aim was to determine how many patients presenting to the emergency department (ED) with nontraumatic LBP had spinal imaging before and after the release of the CWC guideline.
We conducted a retrospective medical record review for patients aged 18-70 years presenting to an academic tertiary care ED with nontraumatic LBP from April 1, 2014 to March 31, 2015 (pre-guideline) and April 1, 2017 to March 31, 2018 (post-guideline).
One-thousand and sixty (545 pre-guideline, 515 post-guideline) patients were included. Pre-guideline, 45 patients (8.3%) had spinal imaging compared to 39 (7.6%) post-guideline (Δ 0.7%; 95% confidence interval [CI] -2.6% to 4.0%). Of the 84 patients (7.9%) who had spinal imaging, 4 (8.9%) had pathologic findings pre-guideline compared to 11 patients (28.2%) post-guideline (Δ 19.3%; 95% CI 2.7% to 35.8%).
CWC guidelines did not appear to alter the rate of imaging for patients presenting to the ED with nontraumatic LBP. Future clinical recommendations should consider active knowledge dissemination and education strategies to help facilitate guideline adoption.
加拿大明智选择（Choosing Wisely Canada，CWC）指南建议，对于没有提示严重潜在病理的临床指标的患者，医生不应为出现非特异性腰痛（low back pain，LBP）的患者开具影像学检查。
我们旨在确定在发布 CWC 指南前后，因非创伤性 LBP 就诊于急诊科（emergency department，ED）的患者中有多少人进行了脊柱影像学检查。
我们对 2014 年 4 月 1 日至 2015 年 3 月 31 日（指南前）和 2017 年 4 月 1 日至 2018 年 3 月 31 日（指南后）因非创伤性 LBP 就诊于学术性三级护理 ED 的 18-70 岁患者进行了回顾性病历审查。
共纳入 1060 例患者（545 例指南前，515 例指南后）。指南前，45 例（8.3%）患者进行了脊柱影像学检查，而指南后为 39 例（7.6%）（差值为 0.7%；95%置信区间[confidence interval，CI]为-2.6%至 4.0%）。在进行了脊柱影像学检查的 84 例患者（7.9%）中，4 例（8.9%）患者在指南前发现了病理性发现，而指南后为 11 例（28.2%）（差值为 19.3%；95%CI 为 2.7%至 35.8%）。
CWC 指南似乎并未改变因非创伤性 LBP 就诊于 ED 的患者进行影像学检查的比率。未来的临床推荐应考虑积极的知识传播和教育策略，以帮助促进指南的采纳。
