Page 17 - Delaware Medical Journal - January 2016
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Evaluation of new onset LBP
Complete history and physical to include:
• Identification of any “red flag” symptoms • Presence of any neurologic deficits
1 or more red flag symptoms No neurologic deficits
Any new neurologic deficits
No red flags
No neurologic deficits
Do not do routine testing, imaging or consults
• Treat symptoms pharmacologically and non-pharmacologically
• Discuss thoroughly
the decision-making process with the patient
• Schedule follow up for at least one month
• Discuss the red flag or neurologic symptoms for which to return to the office or Emergency Department
• Consider further risk stratification with CRP, ESR for inflammatory conditions.
• Perform imaging for identification of cause (see Table 1)
Perform emergent MRI
Edlow23; Horsley24
This recommendation was informed by the American College of Physicians (ACP) and American Pain Society (APS) jointly published 2007 guideline on the diagnosis of LBP. This guideline stated a similar recommendation of no imaging in 21
CONCLUSION AND NEXT STEPS
Much of this discussion regarding the work up of LBP has become common knowledge, but based on the data, has clearly not become common practice. Many of us believe we encourage
with the knowledge that up to 80 percent of acute LBP will alleviate within six to eight weeks. But are we, in Delaware, actually accomplishing it? Are we successfully convincing our patients and colleagues to avoid imaging in benign acute LBP? It is imperative we act on the best available evidence, and Choosing Wisely presents an accessible, relevant place to start. The interventions in the Choosing Wisely recommendations should be avoided in the right clinical circumstances as they do not promote health or improve outcomes. The LBP guidance is unequivocal and has the support of numerous medical societies and groups as listed above.
In Delaware, our group at Christiana Care is working on ways to study the extent of the problem and put evidence-based measures
Del Med J | January 2016 | Vol. 88 | No. 1
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