title: Appropriateness of lumbar spine magnetic resonance imaging in Spain.
abstract: OBJECTIVE
  To determine the minimum percentage of lumbar spine magnetic resonance imaging (LSMRI) which are inappropriately prescribed in routine practice.
  
  
  METHODS
  LSMRI performed prospectively on 602 patients in 12 Radiology Services across 6 regions in Spain, were classified as "appropriate", "uncertain" or "inappropriate" based on the indication criteria established by the National Institute for Clinical Excellence, the American College of Physicians and Radiology, and current evidence-based clinical guidelines. Studies on patients reporting at least one "red flag" were classified as "appropriate". A logistic regression model was developed to identify factors associated with a higher likelihood of inappropriate LSMRI, including gender, reporting of referred pain, health care setting (private/public), and specialty of prescribing physician. Before performing the LSMRI, the radiologists also assessed the appropriateness of the prescription.
  
  
  RESULTS
  Eighty-eight percent of LSMRI were appropriate, 1.3% uncertain and 10.6% inappropriate. The agreement of radiologists' assessment with this classification was substantial (k=0.62). The odds that LSMRI prescriptions were inappropriate were higher for patients without referred pain [OR (CI 95%): 13.75 (6.72; 28.16)], seen in private practice [2.25 (1.20; 4.22)], by orthopedic surgeons, neurosurgeons or primary care physicians [2.50 (1.15; 5.56)].
  
  
  CONCLUSIONS
  Efficiency of LSMRI could be improved in routine practice, without worsening clinical outcomes.
authors: Spanish Back Pain Research Network (REIDE), Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain.
authors: Francisco M
authors: FM
authors: Kovacs
authors: Estanislao
authors: E
authors: Arana
authors: Ana
authors: A
authors: Royuela
authors: Alberto
authors: A
authors: Cabrera
authors: Carlos
authors: C
authors: Casillas
authors: Pilar
authors: P
authors: Piñero
authors: María
authors: M
authors: Vega
authors: Beatriz
authors: B
authors: Asenjo
authors: Ana
authors: A
authors: Estremera
authors: Guillermo
authors: G
authors: Amengual
authors: Helena
authors: H
authors: Sarasíbar
authors: Pilar
authors: P
authors: Ferrer
authors: Antonio
authors: A
authors: Manjarrés
authors: Joaquín
authors: J
authors: Zamarro
authors: Francisco
authors: F
authors: Bravo-Rodríguez
authors: Juan Carlos
authors: JC
authors: Paniagua
authors: Javier
authors: J
authors: Mota
authors: Teresa
authors: T
authors: Sánchez-Sagrado
authors: Víctor
authors: V
authors: Abraira
authors: Carmen
authors: C
authors: Martínez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D055656:Prescriptions / Q000706:statistics & numerical data; D015995:Prevalence; D011843:Radiculopathy / Q000453:epidemiology* / Q000473:pathology*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013030:Spain / Q000453:epidemiology; D013116:Spinal Cord / Q000473:pathology*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review