Imaging use for uncomplicated low back pain by emergency physicians according to the Smarter Medicine recommendations
Bibliographic record
Abstract
Background Low back pain (LBP) is one of the most common causes for emergency department’s (ED) consultation. Usually, LBP is non-specific and associations such as Choosing Wisely Canada (CWC) Emergency Medicine group or Smarter Medicine Switzerland recommend avoidance of lumbosacral imaging for patients with non-traumatic LBP in the absence of red flags. The objective of this study was to determine the adherence to this recommendation in the emergency department of Lausanne University Hospital, Switzerland. The second objective was to determine the factors that may influence the decision to order imaging. Methods We conducted a retrospective observational study over a 1-year period between January 1st and December 31st 2019. All data were collected from patients who presented themselves to the emergency department of Lausanne University Hospital with non-complicated LBP. Patients with red flags and/or who were admitted to the hospital were excluded from the analysis. Results Among a total of 756 eligible patients, 372 were included. Imaging was ordered in 64 (17.20%) of them, including 55 lumbar X-ray, 5 CT-scan and 4 MRI. None of these imaging lead to diagnostic a cause of LBP. Age was the only variable positively associated with imaging (p = .001). There was no statistical difference in the other variables analyzed between these two groups. Conclusions In overall, Choosing Wisely recommendation seems to be respected by the emergency physicians of Lausanne University Hospital although there is a trend toward performing more imaging for older patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".