Abstract
Background
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).
Objective
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.
Methods
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).
Results
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%).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: January 27, 2020
Accepted:
December 16,
2019
Received:
December 12,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
