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提供腰椎影像学报告中的流行病学数据并不影响后续脊柱手术的应用:一项阶梯式随机对照试验的次要结果。

Providing Epidemiological Data in Lumbar Spine Imaging Reports Did Not Affect Subsequent Utilization of Spine Procedures: Secondary Outcomes from a Stepped-Wedge Randomized Controlled Trial.

机构信息

Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, Washington, USA.

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.

出版信息

Pain Med. 2021 Jun 4;22(6):1272-1280. doi: 10.1093/pm/pnab065.

Abstract

OBJECTIVE

To evaluate the effect of inserting epidemiological information into lumbar spine imaging reports on subsequent nonsurgical and surgical procedures involving the thoracolumbosacral spine and sacroiliac joints.

DESIGN

Analysis of secondary outcomes from the Lumbar Imaging with Reporting of Epidemiology (LIRE) pragmatic stepped-wedge randomized trial.

SETTING

Primary care clinics within four integrated health care systems in the United States.

SUBJECTS

238,886 patients ≥18 years of age who received lumbar diagnostic imaging between 2013 and 2016.

METHODS

Clinics were randomized to receive text containing age- and modality-specific epidemiological benchmarks indicating the prevalence of common spine imaging findings in people without low back pain, inserted into lumbar spine imaging reports (the "LIRE intervention"). The study outcomes were receiving 1) any nonsurgical lumbosacral or sacroiliac spine procedure (lumbosacral epidural steroid injection, facet joint injection, or facet joint radiofrequency ablation; or sacroiliac joint injection) or 2) any surgical procedure involving the lumbar, sacral, or thoracic spine (decompression surgery or spinal fusion or other spine surgery).

RESULTS

The LIRE intervention was not significantly associated with subsequent utilization of nonsurgical lumbosacral or sacroiliac spine procedures (odds ratio [OR] = 1.01, 95% confidence interval [CI] 0.93-1.09; P = 0.79) or any surgical procedure (OR = 0.99, 95 CI 0.91-1.07; P = 0.74) involving the lumbar, sacral, or thoracic spine. The intervention was also not significantly associated with any individual spine procedure.

CONCLUSIONS

Inserting epidemiological text into spine imaging reports had no effect on nonsurgical or surgical procedure utilization among patients receiving lumbar diagnostic imaging.

摘要

目的

评估在腰椎影像学报告中插入流行病学信息对随后涉及胸腰椎和骶髂关节的非手术和手术程序的影响。

设计

对腰椎影像学与报告流行病学(LIRE)实用分步楔形随机试验的次要结局进行分析。

设置

美国四个综合医疗保健系统中的初级保健诊所。

受试者

2013 年至 2016 年间接受腰椎诊断成像的 238886 名年龄≥18 岁的患者。

方法

诊所被随机分配接收包含年龄和模式特异性流行病学基准的文本,该文本表明无下腰痛患者常见脊柱成像发现的患病率,插入到腰椎影像学报告中(“LIRE 干预”)。研究结果是接受 1)任何非手术性腰骶或骶髂脊柱程序(腰骶硬膜外类固醇注射、关节突关节注射或关节突关节射频消融;或骶髂关节注射)或 2)任何涉及腰椎、骶骨或胸椎的手术程序(减压手术或脊柱融合或其他脊柱手术)。

结果

LIRE 干预与随后的非手术性腰骶或骶髂脊柱程序的利用(优势比 [OR] = 1.01,95%置信区间 [CI] 0.93-1.09;P = 0.79)或任何涉及腰椎、骶骨或胸椎的手术程序(OR = 0.99,95%CI 0.91-1.07;P = 0.74)均无显著相关性。该干预也与任何单一的脊柱手术程序无显著相关性。

结论

在接受腰椎诊断成像的患者中,将流行病学文本插入脊柱影像学报告中对非手术或手术程序的利用没有影响。

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