Lower back pain is a very common problem with approximately 70-90% of Australians suffering from the condition at some point in their lives1. It was the 5th most common emergency department (ED) presentation in Australia in 20202. Queensland emergency departments have seen a 4-fold increase in presentations from 4410 in 20152 to 18315 in 20202. According to the NSW Emergency Care Institute, more than 85% of patients who present to ED with lower back pain will have no specific aetiology and recover symptomatically within a...

This single-centre retrospective audit included all anonymised patients that underwent a CT lumbar spine from April 2021 to July 2021 in ED at SCUH. Data was extracted via the electronic medical record including the reason for referral and subsequent radiological findings. Results were analysed and the reason for referral was stratified according to the RANZCR choosing wisely Guideline's simplified classification of (1) lower back pain in the setting of radiculopathy (leg pain in L4, L5 and/or S1 nerve root distribution, positive straight leg raise or...

266 consecutive ED patients who underwent CT L-spine were analysed, 63/266 (24%) of the requests were for nonspecific lower back pain and therefore were inappropriate according to the CW recommendations. 59/63 (93.5%) of these patients had no abnormality detected and 4/63 (6.5%) had incidental radiculopathy detected on CT. 179/266 (67%) were appropriately referred in the setting of serious spinal pathology, with 118 out of 179 (66%) found to have no abnormality detected, 60 out of 179 (33.5%) were found to have an acute fracture, and...

This audit demonstrated that almost 1 in 4 CT Lumbar spine requests were inappropriate as they were requested for non-specific back pain with no clinical signs or symptoms of serious pathology, radiculopathy or spinal canal stenosis. Strict compliance with the RANZCR choosing wisely recommendations could have reduced the number of CT lumbar spine CTs by up to 22%. Adherence to the choosing wisely recommendations provides the opportunity to reduce unnecessary ionising radiation exposure and enables significant cost and time savings for both the emergency and...

1. Australian Institute of Health and Welfare. Back problems: Australian Hospital Statistics. Canberra: AIHW;2019. Available from: https://www.aihw.gov.au/getmedia/0d9f8959-2a1c-4c99-8c7e-0c8a878f4d6c/Back%20problems.pdf.aspx?inline=true#:~:text=Estimates%20from%20the%20Australian%20Bureau,some%20point%20in%20their%20lives. 2. Australian Institute of Health and Welfare. Emergency department care 2019-20: Australian Hospital Statistics. Canberra: AIHW;2020.Available from: https://www.aihw.gov.au/getmedia/433caea4-03ff-4569-96ac-042f2844f29c/Emergency-department-care-2019-20.xlsx.aspx 3. Emergency Care Institute. Acute low back pain. ECI;2022. Available from: https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/orthopaedic-and-musculoskeletal/acute-low-back-pain 4. Australian Institute of Health and Welfare. Emergency department care 2014-15: Australian Hospital Statistics. Canberra: AIHW;2015.Available from: https://www.aihw.gov.au/getmedia/0fd096e0-b481-4f92-bfe8-98d72f9c8719/19527_1.pdf.aspx?inline=true 5. Royal Australian and New Zealand College of Radiologists. Choosing Wisely Recommendation 4. 2015.Available from http://www.choosingwisely.org.au/recommendations/ranzcr