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Low back pain accounts for some of the highest health care spending in the U.S. Given how many patients are affected, even small changes in imaging practices could substantially impact health care resource use. A retrospective cohort study led by Mass General Brigham researchers found that only 24 of 2,924 urgent care lumbar spine X-rays for uncomplicated low back pain were followed by emergency department advanced imaging within 30 days.

An urgent care X-ray used about one-quarter of the imaging resources of an emergency department CT or MRI. The results, suggesting that urgent care may be an appropriate, less resource-intensive pathway, are published in the Journal of the American College of Radiology.

"Clinicians need evidence to help decide when advanced imaging is likely to change care and when a less intensive evaluation may be appropriate," said senior author Marc Succi, M.D., emergency radiologist and founder and principal investigator of the IO Lab at Mass General Brigham. "That decision also matters to patients who may otherwise undergo additional testing for findings unrelated to their pain. This affects cost, quality of care and the efficient provisioning of limited resources."

The study analyzed 16,754 lumbar spine imaging studies from 15,759 patients across 23 Mass General Brigham urgent care centers and affiliated emergency departments over seven years. Escalation to emergency department imaging stayed low across urgent care networks, age groups and years, even as urgent care imaging volume nearly doubled.

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