title: Primary care referrals for lumbar spine radiography: diagnostic yield and clinical guidelines.
abstract: BACKGROUND
  Primary care requests for radiographs of the lumbar spine have come under increasing scrutiny. Guidelines aiming to reduce unnecessary radiographs by limiting referrals to patients at high risk of serious disease have been widely distributed. Trial evidence suggests that guidelines can reduce radiography referrals. It is not clear whether this reduction has been achieved in routine practice.
  
  
  OBJECTIVE
  This study, using routine data, was conducted to measure trends in pnmary care referrals for lumbar spine radiography at two hospitals between 1994 and 1999.
  
  
  METHODS
  Analysis of primary care requests for lumbar spine radiography from computerised records.
  
  
  METHODS
  Addenbrooke's Hospital, Cambridge (1 July 1994 to 30 June 1999), and Ipswich General Hospital (1 July 1995 to 30 June 1999), United Kingdom.
  
  
  METHODS
  All primary care requests for lumbar radiography were identified electronically from computerised information systems. A random sample of 2100 radiography reports were classified according to clinical importance. These classifications were used to examine whether the proportion of radiographs demonstrating potentially more serious findings had increased between 1994 and 1999.
  
  
  RESULTS
  There was no evidence that primary care referrals for radiography of the lumbar spine had decreased between 1994 and 1999 at either hospital. General practitioners did not progressively refer more high-risk patients for lumbar radiography. Only a small proportion of patients had important radiographic findings that might warrant specialist referral or specific therapy.
  
  
  CONCLUSIONS
  The implementation of diagnostic guidelines offers much to the NHS. However in these two hospitals, the reduction in radiograph utilisation evident in trials was not achieved. Guideline development is a resource intensive process; distribution must be supported by more effective implementation strategies.
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge. wh108@medschl.cam.ac.uk
authors.forename: William
authors.initials: W
authors.lastname: Hollingworth
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Todd
authors.forename: Hugh
authors.initials: H
authors.lastname: King
authors.forename: Tony
authors.initials: T
authors.lastname: Males
authors.forename: Adrian K
authors.initials: AK
authors.lastname: Dixon
authors.forename: Kanti R
authors.initials: KR
authors.lastname: Karia
authors.forename: Ann Louise
authors.initials: AL
authors.lastname: Kinmonth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004739:England; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000639:trends*; D011859:Radiography; D012017:Referral and Consultation / Q000639:trends*