Surgeons tend to order off-guideline MRIs for workers' comp claimants
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“Some providers, especially those who typically see patients with severe injuries, such as surgeon providers, may routinely image most or all patients,” wrote study authors Janessa M. Graves, MPH, PhD, of the University of Washington in Seattle, and colleagues. “This may result in patients without red flags, or with less severe injuries, receiving early MRI and these providers having higher likelihood of early MRI than others.”
The authors explained that early MRI—meaning within the first four to six weeks of symptoms—is generally not recommended except in patients with certain “red flags,” such as those with an infection, a history of cancer and patients younger than 20 or older than 50.
“Early imaging should be considered a supplemental diagnostic tool for patients with red flags after the completion of a detailed medical history and physical exam,” they explained, though they noted these guidelines are not always followed.
To better understand factors associated with early MRI for low back pain, Graves and colleagues conducted a prospective cohort study of 1,830 injured workers identified from July 2002 to April 2004. In addition to analyzing medical and billing data, telephone interviews were conducted with participants approximately three weeks after claims were filed.
Results showed that in total, 34.4 percent received an MRI within one year, and the mean time to MRI was 60 days. Nearly 20 percent of workers received an early MRI within 42 days of the injury, and among those receiving an early MRI, the mean time to MRI was 21 days.
The initial visit type played a large role in determining whether a patient received an early MRI. Workers whose initial office visit was with a surgeon were 78 percent more likely to undergo early MRI than those who saw a primary care physician. Lower still was the rate of early MRI among patients who first consulted a chiropractor, as these patients were half as likely to receive an MRI as those initially visiting a primary care physician.
Workers with radiculopathy and those with high Roland-Morris disability scores also were more likely to receive an early MRI.
Marital status, body mass index, job satisfaction and health status were not associated with early MRI, according to the authors.
“Understanding factors that are associated with early MRI use will help inform providers and policy makers about current utilization patterns and potential strategies for addressing guideline adherence,” wrote Graves and colleagues.
In an email to Health Imaging, Graves said clinicians should refer to best practice recommendations when making decisions about MRI use or referrals in order to ensure appropriate utilization. “The American College of Radiology and other groups have invested considerable groundwork to create guidelines and appropriateness criteria outlining the best evidence and best practice for MRI use for acute, nonspecific low back pain.” She also pointed to the success of a bill enacted by the Washington State legislature aimed at promoting evidence-based best practice though decision support tools and web-based approval processes.
Evan Godt, Writer
Evan joined TriMed in 2011, writing primarily for Health Imaging. Prior to diving into medical journalism, Evan worked for the Nine Network of Public Media in St. Louis. He also has worked in public relations and education. Evan studied journalism at the University of Missouri, with an emphasis on broadcast media.