Aarhus Universitets segl

Appropriateness of referrals from primary care for lumbar MRI

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review


  • Susanne Brogaard Krogh, Aarhus Universitet
  • ,
  • Tue Secher Jensen
  • Nanna Rolving
  • Janus Nikolaj Laust Thomsen, Aalborg Universitet
  • ,
  • Casper Brink Hansen, Syddansk Universitet
  • ,
  • Christoffer Høj Werenberg, Syddansk Universitet
  • ,
  • Erik Rasmussen, Syddansk Universitet
  • ,
  • Rune Carlson, Syddansk Universitet
  • ,
  • Rikke Krüger Jensen, Syddansk Universitet, Chiropractic Knowledge Hub

Background: International guidelines do not recommend routine imaging, including magnetic resonance imaging (MRI), and seek to guide clinicians only to refer for imaging based on specific indications. Despite this, several studies show an increase in the use of MRI among patients with low back pain (LBP) and an imbalance between appropriate versus inappropriate use of MRI for LBP. This study aimed to investigate to what extent referrals from general practice for lumbar MRI complied with clinical guideline recommendations in a Danish setting, contributing to the understanding and approaches to lumbar MRI for all clinicians managing LBP in the primary sector. Materials and methods: From 2014 to 2018, all referrals for lumbar MRI were included from general practitioners in the Central Denmark Region for diagnostic imaging at a public regional hospital. A modified version of the American College of Radiology Imaging Appropriateness Criteria for LBP was used to classify referrals as appropriate or inappropriate, based on the unstructured text in the GPs’ referrals. Appropriate referrals included fractures, cancer, symptoms persisting for more than 6 weeks of non-surgical treatment, previous surgery, candidate for surgery or suspicion of cauda equina. Inappropriate referrals were sub-classified as lacking information about previous non-surgical treatment and duration. Results: Of the 3772 retrieved referrals for MRI of the lumbar spine, 55% were selected and a total of 2051 referrals were categorised. Approximately one quarter (24.5%) were categorised as appropriate, and 75.5% were deemed inappropriate. 51% of the inappropriate referrals lacked information about previous non-surgical treatment, and 49% had no information about the duration of non-surgical treatment. Apart from minor yearly fluctuations, there was no change in the distribution of appropriate and inappropriate MRI referrals from 2014 to 2018. Conclusion: The majority of lumbar MRI referrals (75.5%) from general practitioners for lumbar MRI did not fulfil the ACR Imaging Appropriateness Criteria for LBP based on the unstructured text of their referrals. There is a need for referrers to include all guideline-relevant information in referrals for imaging. More research is needed to determine whether this is due to patients not fulfilling guideline recommendations or simply the content of the referrals.

TidsskriftChiropractic and Manual Therapies
StatusUdgivet - feb. 2022

Bibliografisk note

Funding Information:
We want to thank Hanne la Cour Ginnerup, medical secretary and Andrew Bolas, REDCap manager, from Regional Hospital Silkeborg for their assistance with data collection.

Funding Information:
RKJ and TSJ are partially employed at the Chiropractic Knowledge Hub funded by the Danish Foundation for Chiropractic Research and Postgraduate Education.

Publisher Copyright:
© 2022, The Author(s).

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