Radiograph utilization and demographics in a chiropractic college teaching clinic

Lew, Makani; Snow, Gregory J.

doi:10.1016/j.jcm.2012.10.003

Cited by 5 publications

(1 citation statement)

References 15 publications

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“…As new evidence emerges about the use of red flags in imaging, guidelines and curricula should be revised accordingly. We found a 3.4% utilization rate for referral for imaging, which is lower than the previously reported 12% utilization at the same teaching institution [8] and the reported range between 8 and 33% for lumbar imaging utilization in other chiropractic teaching clinics [8,16,26]. Our utilization rate is also considerably lower than the 40% utilization rate reported in Canadian and American field chiropractors referring patients for radiographs with non-specific LBP [17], but similar to the 3% reported by French et al in 2022 in a clinical trial aimed to reduce inappropriate imaging in primary care [19].…”

Section: Discussioncontrasting

confidence: 83%

Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study

et al. 2022

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Background: Diagnostic imaging is useful for assessing low back pain (LBP) when a clinician suspects a specific underlying pathology. Evidence-based imaging guidelines assist clinicians in appropriately determining the need for imaging when assessing LBP. A previous study reported high adherence to three clinical guidelines, with utilization rate of 12.3% in imaging of LBP patients attending a chiropractic teaching clinic. A new imaging guideline for spinal disorders has been published and used in teaching. Thus, the aims of our study were to assess the adherence to the new guideline and X-ray utilization in new episodes of LBP. Methods:We conducted a historical clinical cohort study using patient electronic health record audits at seven teaching clinics over a period of 20 months. Records of patients who were at least 18 years of age, presented with a new onset of LBP, and consented to data collection were included. Abstracted data included patient demographics, the number and type of red flags, and the decision to image. Rate of guideline adherence (proportion of those not recommended for imaging, given no red flags) and rate of image utilization were descriptively analyzed. Results:We included 498 patients in this study. At least 81% of included patients had one or more red flags reported. The most commonly reported individual red flag was age ≥ 50 (43.8%) followed by pain at rest (15.7%). In those referred for imaging, age ≥ 50 (93.3%) was the most frequently reported red flag. No red flag(s) were identified in 93 patient records, and none were referred for imaging of their LBP, yielding an adherence rate of 100% (95% CI 96, 100%). A total of 17 of 498 patients were recommended for imaging for their low back pain, resulting in an imaging utilization rate of 3.4% (95% CI 1.8, 5.0%). Conclusion:The imaging utilization rate was 3.4%, lower than 12.3% previously reported at a chiropractic teaching clinic. None without red flags were referred for imaging, yielding a 100%, adherence rate to current LBP imaging guidelines. Future research should consider currency of guideline, accuracy of red flags and factors influencing clinicians' decision, when assessing imaging adherence rates.

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Section: Discussioncontrasting

confidence: 83%

Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study

et al. 2022

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Use of Radiography for New Patients Presenting to a Chiropractic Teaching Clinic: A Cross-sectional Analysis

Kioh

Pooke

Chong

2021

Journal of Chiropractic Humanities

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Current evidence for spinal X-ray use in the chiropractic profession: a narrative review

et al. 2018

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The use of routine spinal X-rays within chiropractic has a contentious history. Elements of the profession advocate for the need for routine spinal X-rays to improve patient management, whereas other chiropractors advocate using spinal X-rays only when endorsed by current imaging guidelines. This review aims to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. Current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis. Strong evidence demonstrates risks of imaging such as excessive radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased costs. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.

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Radiograph utilization and demographics in a chiropractic college teaching clinic

Cited by 5 publications

References 15 publications

Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study

Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study

Use of Radiography for New Patients Presenting to a Chiropractic Teaching Clinic: A Cross-sectional Analysis

Current evidence for spinal X-ray use in the chiropractic profession: a narrative review

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