Utilization of lumbosacral spine radiographs for the evaluation of low back pain in the emergency department

We sought to determine how often Emergency Physicians (EPs) order plain rad iographs (XRs) of the lumbosacral spine in evaluating patients with low bac k pain (LBP). In addition, we sought to determine what history and physical examination findings were statistically associated with the use of an XR. Patients evaluated in our Emergency Department (ED) between April 1, 1995 a nd September 30, 1995 for LBP were identified retrospectively by their ICD- 9 discharge code, The ED record was reviewed, and an odds ratio (OR) was ca lculated for each of several history and physical examination findings, to determine which of them increased the likelihood of having an XR. Forty of 214 patients (19%) with LBP had an XR done. Patient characteristics associa ted with the use of an XR were: a positive straight leg examination, age > 50 years, a history of trauma, and vertebral tenderness. In this series, on ly a small minority of patients with LBP had an XR done as part of their ED evaluation. The choice of which patients to image was determined by histor y and physical examination findings. We conclude that the EPs we studied ar e evaluating LBP as conservatively, if not more so, than physicians in othe r specialties. (C) 1999 Elsevier Science Inc.