IS THERE A CASE TO INCREASE THE AGE RELATED RED FLAG CRITERIA FROM 55 TO 70 TO ORDER LUMBAR SPINE X-RAYS IN BACK PAIN?

Purpose of study The Royal College of Radiology (RCR) provides guideline criteria to order lumbar spine X-rays for back pain. An audit was undertaken in our hospital to see compliance with this guideline. Methods 200 lumbar spine radiology requests received in the hospital radiology department from General Practitioners over a 12 month period were identified. These 200 requests and their corresponding radiology reports were retrospectively analyzed. Results Out of the 200 patients 80 were male and 120 were female. 1 patient was 70 years of age. Only 125 patients satisfied the RCR criteria for requiring a Lumbar Spine X-ray. 104 of these 125 patients met the criteria only because of age (> 55). The remaining 21 had other criteria like history of malignancy, osteoporosis or trauma that required imaging. Of the 200 X-rays the only significant pathology that was identified from the report was osteoporotic fractures in 35 patients. The most commonest diagnostic report was spondylosis which was seen in 92 patients. Among the 75 patients between the age of 18 and 55 only 2 fulfilled the criteria for requiring a lumbar spine X-ray. Hence 73 (36.5%) X-rays were outside the criteria. Among the 52 patients between the ages of 55 and 70 only 6 had a criteria other than age. Conclusion This limited study demonstrates the following two possibilities More stricter adherence to guidelines in patients aged 18 to 55. In this study 73 (36.5%) X-rays could have been avoided by this method. We believe that there is a case for the college to increase the age related criteria from 55 to 70 to be at par with American guidelines. If this method was used an additional 46 (23%) X-rays could have been avoided.