腰背疼痛的影像学诊断.pdfVIP

Clinical Guideline Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians Roger Chou, MD; Amir Qaseem, MD, PhD, MHA; Douglas K. Owens, MD, MS; and Paul Shekelle, MD, PhD, for the Clinical Guidelines Committee of the American College of Physicians* Diagnostic imaging is indicated for patients with low back pain only testing does not equate to better care. Implementing a selective if they have severe progressive neurologic deficits or signs or symp- approach to low back imaging, as suggested by the American toms that suggest a serious or specific underlying condition. In College of Physicians and American Pain Society guideline on low other patients, evidence indicates that routine imaging is not asso- back pain, would provide better care to patients, improve out- ciated with clinically meaningful benefits but can lead to harms. comes, and reduce costs. Addressing inefficiencies in diagnostic testing could minimize poten- tial harms to patients and have a large effect on use of resources by Ann Intern Med. 2011;154:181-189. reducing both direct and downstream costs. In this area, more For author affiliations, see end of text. ow back pain is very common (1, 2), and many patients Despite increased spending on low back pain, U.S. L with low back pain receive routine spinal imaging adults with spine problems reported similar or worse scores (lumbar radiography, computed tomography [CT], or for mental health, physical functioning, work or school magnetic resonance imaging [MRI]) (3, 4), despite limitations, and