Influence of Imaging on Clinical Decision Making in the Treatment of Lower Back Pain

Gillan, Maureen Gc; Gilbert, Fiona J; Andrew, Jane; Grant, Adrian; Wardlaw, Douglas; Valentine, Neil W.; Gregori, Alberto C.

doi:10.1148/radiology.220.2.r01au06393

Cited by 51 publications

(24 citation statements)

References 27 publications

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“…This is in line with a study of 145 patients with low back pain who were randomly assigned to ''no imaging'' and ''imaging'' groups. There was no difference in diagnosis or treatment plan between groups, but the clinicians' diagnostic and treatment confidence were greater in the ''imaging'' group compared with the group that did not have imaging [10]. More advanced CT-based measuring methods, such as quantitative 3-D CT analysis, might improve fracture assessment and result in greater agreement when recommending treatment [19].…”

Section: Discussionmentioning

confidence: 91%

Greater Tuberosity Fractures: Does Fracture Assessment and Treatment Recommendation Vary Based on Imaging Modality?

Janssen

Hermanussen

Guitton

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background For greater tuberosity fractures, 5-mm displacement is a commonly used threshold for recommending surgery; however, it is unclear if displacement can be assessed with this degree of precision and reliability using plain radiographs. It also is unclear if CT images provide additional information that might change decision making. Question/Purposes We asked: (1) Does interobserver agreement for assessment of the amount and direction of fracture-fragment displacement vary based on imaging modality (radiographs only; 2-dimensional [2-D] CT images and radiographs; and 3-dimensional [3-D] and 2-D CT images and radiographs)? (2) Does the likelihood of recommending surgery vary based on imaging modality? (3) Does the level of confidence regarding the decision for treatment vary based on imaging modality? Methods We invited 791 orthopaedic surgeons to complete a survey on greater tuberosity fractures. One hundred eighty (23%) responded and were randomized on a 1:1:1 basis in one of the three imaging modality groups and evaluated the same set of 22 fractures. We described age, sex, mechanism of injury, days between injury and imaging, and that patients had no comorbidities or signs of neurovascular damage for every case. One hundred sixty-four of the 180 respondents completed the study and there was an imbalance in noncompletion between the three groups (two of 67 [3.0%] in the radiograph only group; nine of 57 [16%] in the 2-D CT and radiograph group; and five of 56 [8.9%] in the 3-D CT, 2-D CT, and radiograph group; p = 0.043 by Fisher's exact test). Participants assessed amount (in millimeters) and direction (posterosuperior/posteroinferior/ anterosuperior/anteroinferior/no displacement) of displacement; recommended treatment (surgical or nonoperative); and indicated their level of confidence regarding the recommended treatment on a scale from 0 to 10 for every case. Overall recommendation for treatment was expressed as a surgery score per surgeon by dividing the amount of cases they would operate on by the total number of cases (n = 22) and presented as a percentage. Confidence regarding the One of the authors (DR) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Wright Medical (Memphis, TN, USA); an amount less than USD 10,000 from Skeletal Dynamics (Miami, FL, USA); an amount less than USD 10,000 from Biomet (Warsaw, IN, USA); an amount less than USD 10,000 from AO North America (Paoli, PA, USA); and an amount less than USD 10,000 from AO International (Dubendorf, Switzerland). One of the authors (HHH) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from the Anna Foundation (The Netherlands); an amount less than USD 10,000 from the Marco Polo Fund (The Netherlands); and an amount less than USD 10,000 from the Groningen University Fund (The Netherlands). All ICMJE Conflict of Interest...

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Section: Discussionmentioning

confidence: 91%

Greater Tuberosity Fractures: Does Fracture Assessment and Treatment Recommendation Vary Based on Imaging Modality?

Janssen

Hermanussen

Guitton

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…However, the fact that reports are standardized does not necessarily mean that they provide clinically relevant information. [2][3][4]29 In fact, correlation between clinical and radiologic findings should always be prioritized. 2 Current recommendations for grading degenerative spine disease propose the use of scales with 3-5 grades, starting with the "not degenerated" state.…”

Section: Discussionmentioning

confidence: 99%

Influence of Nomenclature in the Interpretation of Lumbar Disk Contour on MR Imaging: A Comparison of the Agreement Using the Combined Task Force and the Nordic Nomenclatures

Arana¹,

Kovacs²,

Royuela³

et al. 2011

AJNR Am J Neuroradiol

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“…For instance, even cash-constrained hospitals can decide to allocate extra resources to measures of 'care' that can reduce liability risk. In addition, there is evidence that NHS physicians can exercise discretion in the application of such measures (for example, Gillan et al, 2001, discuss the discretionary use of radiology in treatment of lower back pain).…”

Section: Table 5 Near Herementioning

confidence: 99%

Enterprise Liability, Risk Pooling, and Diagnostic Care

Fenn

Gray

Rickman

et al. 2010

Journal of Public Administration Research and Theory

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The safety of patients is an important responsibility of health care providers, and significant compensation costs may arise if providers are negligent. A widely debated option involves liability for such compensation being placed with the hospital rather than the individual clinician, a system known as "enterprise liability". In the US, partial adoption of enterprise liability, and proposals for its universal introduction, have accompanied high profile "malpractice insurance crises" in the last two decades.Hospitals in England and Wales have been subject to this system since 1990, and risk pooling arrangements have emerged subsequently allowing hospitals to transfer their liability risk to an agency known as the NHS Litigation Authority. We explore some of the mechanisms used by this agency to provide hospital management with financial incentives to take care. We estimate the influence of these arrangements on the use of diagnostic imaging tests within hospitals, using a panel data set covering the period 2000-2004, during which period a policy shift took place leading to a form of "natural experiment". Our results suggest that the use of diagnostic tests did not respond to the incentives created during this period. We speculate that certain types of patient care activity, including the use of diagnostic tests, may be less responsive to incentives placed at the level of the hospital by comparison with incentives placed at the level of the clinician. Our findings may have implications for jurisdictions contemplating a move to enterprise liability, as well as wider implications for public sector organizations faced with financial incentives to improve service quality. DRAFT -DO NOT QUOTE

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Influence of Imaging on Clinical Decision Making in the Treatment of Lower Back Pain

Abstract: Imaging may increase diagnostic confidence but has minimal influence on diagnostic or therapeutic decisions for patients with LBP. The results highlight the need for evidence-based guidelines for imaging in LBP treatment.

Cited by 51 publications

References 27 publications

Greater Tuberosity Fractures: Does Fracture Assessment and Treatment Recommendation Vary Based on Imaging Modality?

Greater Tuberosity Fractures: Does Fracture Assessment and Treatment Recommendation Vary Based on Imaging Modality?

Influence of Nomenclature in the Interpretation of Lumbar Disk Contour on MR Imaging: A Comparison of the Agreement Using the Combined Task Force and the Nordic Nomenclatures

Enterprise Liability, Risk Pooling, and Diagnostic Care

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