CHA Family Medicine Residency

Tufts family medicine residents have "the best of both worlds"

Early Imaging for Back Pain

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Today we discussed early imaging in back pain.

Jarvik JG et al. “Association of Early Imaging for Back Pain with Clinical Outcomes in Older Adults.” JAMA 2015; 313 (11): 1143-1153.

Population: 5k patients who are, according to the #’s, mostly white, over 65, with a high school or higher education, but with a smattering of other races and educational levels thrown in. Drawn from Harvard Vanguard, Kaiser Permanente of NoCA, and Henry Ford health systems.
Excluded: people with cancer or back surgery

Intervention: early back imaging < 6 weeks from “index visit”

Control: propensity-matched controls that did NOT undergo imaging

Outcome: Patient self-reported pain/function/depression at different intervals, mainly 3-, 6-, and 12-month intervals. Basically, 1300-1500 dollars more usage per patient in those who undergo early imaging. The short version is: early imaging largely results in same outcomes with more health care costs. Proportion of cancer diagnoses were not statistically different between the two groups!

Limitations of study: patient-reported data and a morass of CPT, ICD9, and RVU data pulled from medical records. How to account for osteoporotic patients?

Short version: you can safely avoid getting early (< 6 weeks) imaging in older folks who present with your basic back pain visit without worrying about “missing something.”

Why did this study matter? Most back pain literature is based on younger < 65 year old peeps.

Questions? Concerns? Comments?
-Danielle

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