CHICAGO – Researchers from the University of Aberdeen Medical School in Scotland presented evidence today at the RSNA that imaging technologies such as CT and MR may be being used unnecessarily and inappropriately for many patients with low back pain (LBP).
Dr. Fiona Gilbert and colleagues created a study to assess the impact of resource-intensive technologies such as MR and CT on clinical decision-making in the management of LBP. The research examined 145 patients, in a controlled before-and-after study, with symptomatic lumbar spine disorders referred to either an orthopedic specialist or neurosurgeon and for whom there was clinical uncertainty about whether or when to perform imaging.
After giving informed consent, patients were randomized to an imaging or no imaging group. Paired assessments were made of diagnosis, diagnostic confidence, proposed management, and management confidence at trial entry and follow-up (both at 8 and 24 months). An intention-to-treat analysis was performed on the groups as randomized, to reduce the risk of selection bias.
At follow-up there were no statistically significant differences between the randomization groups with respect to changes in diagnosis or management plans. Changes in diagnostic category were reported for 35 of 81 patients (43%) in the imaging group and 34 of 63 (54%) in the no imaging group.
The authors observed that treatment plans were unchanged for approximately 50% of patients in both groups. However, there was a significant increase in diagnostic and therapeutic confidence for both groups, with a significantly greater increase in diagnostic confidence for the imaging group.
Although imaging may increase diagnostic confidence, the research found no evidence that this led to changes in diagnostic category or management plans for these LBP patients. The researchers noted that data of previous before-and-after observational studies that did not include a control group may have overestimated the contribution of imaging to clinical decision-making.
By Jonathan S. Batchelor
AuntMinnie.com staff writer
November 29, 2000
Dr. Fiona Gilbert and colleagues created a study to assess the impact of resource-intensive technologies such as MR and CT on clinical decision-making in the management of LBP. The research examined 145 patients, in a controlled before-and-after study, with symptomatic lumbar spine disorders referred to either an orthopedic specialist or neurosurgeon and for whom there was clinical uncertainty about whether or when to perform imaging.
After giving informed consent, patients were randomized to an imaging or no imaging group. Paired assessments were made of diagnosis, diagnostic confidence, proposed management, and management confidence at trial entry and follow-up (both at 8 and 24 months). An intention-to-treat analysis was performed on the groups as randomized, to reduce the risk of selection bias.
At follow-up there were no statistically significant differences between the randomization groups with respect to changes in diagnosis or management plans. Changes in diagnostic category were reported for 35 of 81 patients (43%) in the imaging group and 34 of 63 (54%) in the no imaging group.
The authors observed that treatment plans were unchanged for approximately 50% of patients in both groups. However, there was a significant increase in diagnostic and therapeutic confidence for both groups, with a significantly greater increase in diagnostic confidence for the imaging group.
Although imaging may increase diagnostic confidence, the research found no evidence that this led to changes in diagnostic category or management plans for these LBP patients. The researchers noted that data of previous before-and-after observational studies that did not include a control group may have overestimated the contribution of imaging to clinical decision-making.
By Jonathan S. Batchelor
AuntMinnie.com staff writer
November 29, 2000
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