title: [Quality Assurance using routine data: Overdiagnosis by radiological imaging for back pain].
abstract: Background and Problem: Acute nonspecific back pain disorders are typically self-limiting. According to the national guideline low back pain, only in case of clinical suspicion of a serious course radiological imaging should take place immediately. Otherwise, the guideline recommends waiting at least six weeks.
  
  
  METHODS
  Using Statutory Health Insurance (SHI) routine data of the Techniker Krankenkasse we analyzed how many of the insured persons suffering from acute back pain for the first time with no indication of a serious outcome received a non-indicated diagnostic imaging.
  
  
  RESULTS
  In about 10 % diagnostic imaging is conducted after initial diagnosis. If an imaging is carried out, roughly one third of these cases takes place ahead of time or is completely unnecessary. Methodically this is a very conservative estimation, thus it seems likely that the extent of overdiagnosis in actual medical care situation is even larger.
  
  
  CONCLUSIONS
  Every third patient who received radiological diagnostics due to first acute nonspecific back pain underwent the procedure more quickly than recommended (less than six weeks). Overdiagnosis is not only economically problematic but also with respect to patient orientation and patient safety. It may cause substantial damage to patients - either by the use of diagnostics itself or by means of therapies initiated after diagnostics.
authors.forename: R
authors.initials: R
authors.lastname: Linder
authors.forename: D
authors.initials: D
authors.lastname: Horenkamp-Sonntag
authors.forename: S
authors.initials: S
authors.lastname: Engel
authors.forename: U
authors.initials: U
authors.lastname: Schneider
authors.forename: F
authors.initials: F
authors.lastname: Verheyen
mesh_terms: D001416:Back Pain / Q000000981:diagnostic imaging* / Q000191:economics / Q000209:etiology / Q000628:therapy; D003365:Costs and Cost Analysis; D003937:Diagnosis, Differential; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D000069342:Medical Overuse / Q000191:economics / Q000706:statistics & numerical data*; D009313:National Health Programs / Q000191:economics; D011785:Quality Assurance, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D057832:Watchful Waiting