Radiography of Lumbosacral Column in Acute Lumbar Pain: Use or Overuse? Experience in the Emergency Service of Two High-Complexity Centers in Bogotá, Colombia

Authors

  • Martha Rocío Vargas Gayón Fundación Universitaria Sanitas. Bogotá.
  • Martha Catalina Wilches Clínica Reina Sofía.
  • Kelly Estrada Orozco Clínica Universitaria Colombia y Clínica Reina Sofía.

DOI:

https://doi.org/10.53903/01212095.68

Keywords:

Low back pain, Lumbosacral region, Health care costs

Abstract

Introduction: Low back pain is a disease with a high frequency and a recurrence worldwide, there are Introduction: Low back pain is a high frequency disease with a high recurrence worldwide. There are absolute indications to request radiography, avoiding its increase and associated costs. Objective: To determine the frequency of the use of lumbosacral spine radiography requested to adult patients with acute low back pain who entered the emergency room at two clinics of high complexity during 2016 and the associated costs. Methodology: Descriptive cross-sectional study. Sample of 192 patient diagnosed with acute low back pain with lumbosacral spine radiography and who met the inclusion criterio. The prevalence of red flags were calculated, symptoms and background that justified the request, as well as the main radiological findings of unjustified radiographs and their associated costs. Results: The frequency of the request for radiography in the emergency departments related to low back pain was 56.43%. More than half of the radiological findings are degenerative. 13.54% of the radiographs were not indicated by red flags and 9.37% were not indicated by red flags or associated symptoms. The associated costs were 15.926 USD /year. Conclusions: Lumbosacral spine radiography has a low diagnostic yield in patients with acute low back pain who enter the emergency room due to low specificity and low sensitivity, lack of patient preparation, and should not be requested in this service, unless there is high suspicion, with a physical examination and exhaustive interrogation.

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References

Ramírez J, Anzola L, Segura J, Silva A, Sierra J, Rugeles J, et al. Dolor lumbar desde la perspectiva del clínico hasta las imágenes diagnósticas. Bogotá: Fundación Universitaria Sanitas; 2010.

Kinkade S. Evaluation and treatment of acute low back pain. Am Fam Physician. 2007;75:1181-8.

Díaz R, Marulanda F, Sáenz X. Estudio epidemiológico del dolor crónico en Caldas, Colombia (Estudio DOLCA). Acta Médica Colombiana. 2009;34(3). 4. Santos García P. Repercusión de la patología dolorosa lumbar en una población laboral y análisis de la efectividad de las medidas correctoras propuestas. España: Universidad de Murcia; 2012.

Uribe CR. Dolor lumbar: una aproximación general basada en la evidencia. Univ. Méd. Bogotá (Colombia). 2008;49(4):509-20.

Van Tulder M, Becker A, Bekkering T, Breen A, Gil del Real M T, Hutchinson A, et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl.2):S169-91.

Ruiz SF, Guzmán L, Tello M, Navarrete PJ. La radiografía simple en el estudio del dolor de la columna vertebral. Radiología. 2010;52(2):126-37.

Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin. 2007;25:353-71.

Pérez Irazusta I, Alcorta Michelena I, Aguirre Lejarcegui G, Aristegui Racero G, Caso Martínez J, Esquisabel Martínez R. Guía de práctica clínica sobre lumbalgia. Osakidetza. 2007.

Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268(6):760-5.

Miller P, Kendrick D, Bentley E, Fielding K. Cost-effectiveness lumbar spine radiography in primary care patients with low back pain. Spine (Phila Pa 1976). 2002;27(20):2291-7.

Hollingworth W, Todd CJ, King H, Males T, Dixon AK, Karia KR, Kinmonth AL. Primary care referals for lumbar spine radiography: diagnostic yield and clinical guidelines. Br J Gen Pract. 2002;52(479):475-80.

Kendrick D, Fielding K, Bentley E, Miller P, Kerslake R, Pringle M. The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomised (unblinded) controlled trial. Health Technol Assess. 2001;5(30).

Gunther U, Wünschel M, Socci M, et al. Spine radiography in the evaluation of back and neck pain in an orthopaedic emergency clinic. J Back Musculoskeletal Rehabilitation. 2015;28:43-8.

Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344:363-70.

Chou R, Qaseem A, Owens D, et al. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. American College of Physicians. 2011.

Leichtle U, Wünschel M, Socci M, Kurze C, Niemeyer T, Leichtle C. Spine radiography in the evaluation of back and neck pain in an orthopaedic emergency clinic. J Back Musculoskeletal Rehabilitation. 2015;28(1):43-8.

Published

2019-06-30

How to Cite

(1)
Vargas Gayón, M. R. .; Wilches, M. C. .; Estrada Orozco, K. . Radiography of Lumbosacral Column in Acute Lumbar Pain: Use or Overuse? Experience in the Emergency Service of Two High-Complexity Centers in Bogotá, Colombia. Rev. colomb. radiol. 2019, 30, 5126-5131.

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Section

Research articles
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