Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Dr, St. John's, NL, A1B 3V6, Canada.
Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, NL, Canada.
BMC Fam Pract. 2020 Nov 18;21(1):236. doi: 10.1186/s12875-020-01308-5.
CT Imaging is often requested for patients with low back pain (LBP) by their general practitioners. It is currently unknown what reasons are common for these referrals and if CT images are ordered according to guidelines in one province in Canada, which has high rates of CT imaging. The objective of this study is to categorise lumbar spine CT referrals into serious spinal pathology, radicular syndrome, and non-specific LBP and evaluate the appropriateness of CT imaging referrals from general practitioners for patients with LBP.
A retrospective medical record review of electronic health records was performed in one health region in Newfoundland and Labrador, Canada. Inclusion criteria were lumbar spine CT referrals ordered by general practitioners for adults ≥18 years, and performed between January 1st-December 31st, 2016. Each CT referral was identified from linked databases (Meditech and PACS). To the study authors' knowledge, guidelines regarding when to refer patients with low back pain for CT imaging had not been actively disseminated to general practitioners or implemented at clinics/hospitals during this time period. Data were manually extracted and categorised into three groups: red flag conditions (judged to be an appropriate referral), radicular syndrome (judged be unclear appropriateness), or nonspecific LBP (determined to be inappropriate).
Three thousand six hundred nine lumbar spine CTs were included from 2016. The mean age of participants was 54.7 (SD 14 years), with females comprising 54.6% of referrals. 1.9% of lumbar CT referrals were missing/unclear, 6.5% of CTs were ordered on a red-flag suspicion, 75.6% for radicular syndromes, and 16.0% for non-specific LBP; only 6.5% of referrals were clearly appropriate. Key information including patient history and clinical exams performed at appointment were often missing from referrals.
This audit found high proportions of inappropriate or questionable referrals for lumbar spine CT and many were missing information needed to categorise. Further research to understand the drivers of inappropriate imaging and cost to the healthcare system would be beneficial.
全科医生经常为腰痛（LBP）患者开 CT 影像检查。目前尚不清楚这些转诊的常见原因是什么，以及在加拿大一个 CT 影像率较高的省份，是否根据指南来开 CT 影像检查单。本研究的目的是将腰椎 CT 转诊分为严重脊柱病变、神经根综合征和非特异性 LBP，并评估全科医生为腰痛患者开 CT 影像检查单的适宜性。
对加拿大纽芬兰和拉布拉多省一个卫生区域的电子健康记录进行了回顾性病历审查。纳入标准为全科医生为 18 岁及以上成年人开的腰椎 CT 转诊，并于 2016 年 1 月 1 日至 12 月 31 日进行。每个 CT 转诊都是从链接数据库（Meditech 和 PACS）中识别出来的。据研究作者所知，在此期间，没有向全科医生积极传播或在诊所/医院实施有关何时为腰痛患者转诊进行 CT 影像检查的指南。数据是手动提取并分为三组：红旗条件（判断为适当转诊）、神经根综合征（判断为适当性不明确）或非特异性 LBP（确定为不适当）。
2016 年共纳入 3609 例腰椎 CT。参与者的平均年龄为 54.7（14 岁标准差），女性占转诊的 54.6%。1.9%的腰椎 CT 转诊缺失/不明确，6.5%的 CT 是基于红旗怀疑而开的，75.6%是为神经根综合征，16.0%是非特异性 LBP；只有 6.5%的转诊是明确适当的。转诊中经常缺少关键信息，包括患者病史和就诊时进行的临床检查。
本审计发现，腰椎 CT 不适当或可疑转诊的比例较高，而且许多转诊都缺少分类所需的信息。进一步研究了解不适当成像的驱动因素和对医疗保健系统的成本将是有益的。
