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Journal Club: Ouch, my back hurts! Can I go home now?

Imaging Strategies in Low Back Pain: Systematic Review and Meta-analysis

Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009 Feb 7;373(9662):463-72. doi: 10.1016/S0140-6736(09)60172-0. PMID: 19200918.

This study looked at patients presenting to a primary care setting with low back pain and no red flag symptoms. It compared those who underwent immediate lumbar imaging vs usual clinical care without immediate imaging. Outcomes included pain, function, quality of life, and mental health. While this population may not represent the acuity or severity of our population in the ED, it does indicate there is a relative infrequency to serious etiologies of low back pain in the absence of red flag symptoms. It also highlights the negative aspects of obtaining imaging, including identifying abnormalities that may not be the cause of the patient's symptoms, and higher rates of surgical intervention with no change in outcomes.

Red Flags for Low Back Pain Are Not Always Really Red: A prospective evaluation of the clinical utility of commonly used screening questions for low back pain

Premkumar A, Godfrey W, Gottschalk MB, Boden SD. Red Flags for Low Back Pain Are Not Always Really Red: A Prospective Evaluation of the Clinical Utility of Commonly Used Screening Questions for Low Back Pain. J Bone Joint Surg Am. 2018 Mar 7;100(5):368-374. doi: 10.2106/JBJS.17.00134. PMID: 29509613.

This retrospective review looked at 9,940 patients presenting with low back pain and matched up the presence of "red flag" symptoms with various serious etiologies, including fracture, malignancy, infection, and cauda equina. The "red flag' characteristics included were age >50, age >70, trauma, pain awakening from sleep, unexplained weight loss, history of cancer, fevers, chills, sweating, recent infection, recent loss of bowel control, recent loss of bladder control. The results were quite surprising in that while many of the "red flag" characteristics had very good specificities and positive predictive values, the sensitivity of almost all of these characteristics were staggeringly low. In summary, while these characteristics can be used to help rule-in diagnoses, they should not be used to rule-out diagnoses.


Journal Club Discussion Leader: Steven Terry, MD (PGY-2)

2021-2022 Academic Year Journal Club Leaders: Rose Solomon, MD (PGY-3); Jarred Worthy, DO (PGY-2); David Andonian, MD (Faculty Advisor)

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