Radiograph use in low back pain: a United States Emergency Department database analysis

J Emerg Med. 2004 Jan;26(1):37-45. doi: 10.1016/j.jemermed.2003.06.002.


We identified factors associated with radiograph evaluation for patients who presented to the Emergency Department (ED) with uncomplicated low back pain (LBP). Using 1998-2000 ED data from the National Hospital Ambulatory Medical Care Survey, a multivariate analysis was performed to assess utilization of radiographs for LBP. Based upon published guidelines, of the over 3 million patients who met our criteria of uncomplicated LBP, 17.8% received an unnecessary radiograph. Patients who arrive via ambulance with moderate pain, who need to be seen within 15 min, and who have 3 or more screening tests ordered are 100% likely to also get a radiograph. There is an increased probability of receiving a radiograph for those patients 40-70 years old, being seen at a metropolitan hospital, having private insurance, and being treated by a resident in training. Multiple factors are associated with the overuse of radiographs for patients presenting with uncomplicated LBP.

MeSH terms

  • Adolescent
  • Adult
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Logistic Models
  • Low Back Pain / diagnostic imaging*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Radiography
  • Retrospective Studies
  • United States