aportes a la gestión necesaria para la sustentabilidad de la SALUD PÚBLICA como figura esencial de los servicios sociales básicos para la sociedad humana, para la familia y para la persona como individuo que participa de la vida ciudadana.
miércoles, 8 de abril de 2015
Association of early imaging for back pain with clinical outcomes in older adults. - PubMed - NCBI
Older adults who had spine imaging within six weeks of an initial primary care visit for back pain did not have better outcomes one year later when compared with those who did not have early imaging, according to a recent AHRQ-funded study. Patients who had early imaging had substantially higher health care use and costs than those who did not undergo early imaging, the study said. Researchers examined data from 5,239 patients age 65 years and older who went to primary- or urgent-care facilities at three U.S. health care systems for back pain over a two-year period. The study and abstract, “Association of Early Imaging for Back Pain with Clinical Outcomes in Older Adults,” was published in the March 17 issue of the Journal of the American Medical Association.
JAMA. 2015 Mar 17;313(11):1143-53. doi: 10.1001/jama.2015.1871.
Association of early imaging for back pain with clinical outcomes in older adults.
In contrast to the recommendations for younger adults, many guidelines allow for older adults with back pain to undergo imaging without waiting 4 to 6 weeks. However, early imaging may precipitate interventions that do not improve outcomes.
To compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy.
DESIGN, SETTING, AND PARTICIPANTS:
Prospective cohort of 5239 patients 65 years or older with a new primary care visit for back pain (2011-2013) in 3 US health care systems. We matched controls 1:1 using propensity score matching of demographic and clinical characteristics, including diagnosis, pain severity, pain duration, functional status, and prior resource use.
Diagnostic imaging (plain films, computed tomography [CT], magnetic resonance imaging [MRI]) of the lumbar or thoracic spine within 6 weeks of the index visit.
MAIN OUTCOME AND MEASURES:
back or leg pain-related disability measured by the modified Roland-Morris Disability Questionnaire (score range, 0-24; higher scores indicate greater disability) 12 months after enrollment.
Among the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, -0.10 [95% CI, -0.71 to 0.50]; mixed model, P = .36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,-0.51 [-1.62 to 0.60]; mixed model, P = .18).
CONCLUSIONS AND RELEVANCE:
Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.
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