title: Imaging for patients presenting to an emergency department with back pain: Impact on patient pathway.
abstract: OBJECTIVE
  The objective of the present study is to quantify utilisation of imaging for patients presenting to an ED with back pain, their characteristics and dispositions.
  
  
  METHODS
  A retrospective cohort study of 1132 ED presentations for back pain to an Australian metropolitan ED in 2013 was performed. Patient demographics, rates of radiography, computed tomography or magnetic resonance imaging and rates of subsequent admission and ED re-presentation were analysed.
  
  
  RESULTS
  Patients aged 26-35 years were the largest group presenting with back pain (19.4% of presentations), with the majority being female (52.3%). Imaging was requested at 29.5% (n = 334) of presentations (radiography n = 297; advanced imaging n = 63). Patients over 70 years had higher imaging rates than younger patients (49.4% vs 25.5%, P < 0.001). Imaging was not associated with attendance during or outside office hours (29.3% vs 31.8%, P = 0.4). Of presentations, 34.1% resulted in admission, with no association between imaging and admission (31.8% vs 36.0%, P = 0.2) or ED re-presentation for back pain in the same year (6.5% vs 9.7%, P = 0.09).
  
  
  CONCLUSIONS
  This study provides benchmark data on the use of imaging for back pain in an Australian ED, an area which has been largely unexplored. The rate of imaging in the ED was higher than previously reported in a General Practice setting. Consistent with guidelines, patients older than 70 were more than twice as likely to receive imaging compared to younger patients. It was beyond the scope of the current study to determine whether these images were clinically indicated and further research is required to determine if initiatives to reduce imaging in this population are warranted.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Euan J
authors.identifier: http://orcid.org/0000-0001-6596-110X
authors.initials: EJ
authors.lastname: McCaughey
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Georgiou
authors.affiliation: Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, Australia.|Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Michael Hg
authors.initials: MH
authors.lastname: Golding
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Johanna I
authors.initials: JI
authors.lastname: Westbrook
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000000981:diagnostic imaging*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009517:New South Wales; D012189:Retrospective Studies
keywords: back pain; emergency department; imaging; radiography