Beschreibung:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Low back pain (<jats:styled-content style="fixed-case">LBP</jats:styled-content>) is an extremely frequent reason for patients to present to an emergency department (<jats:styled-content style="fixed-case">ED</jats:styled-content>). Despite evidence against the utility of imaging, simple and advanced imaging (i.e., computed tomography [<jats:styled-content style="fixed-case">CT</jats:styled-content>], magnetic resonance imaging) for patients with <jats:styled-content style="fixed-case">LBP</jats:styled-content> has become increasingly frequent in the <jats:styled-content style="fixed-case">ED</jats:styled-content>. The objective of this review was to identify and examine the effectiveness of interventions aimed at reducing image ordering in the <jats:styled-content style="fixed-case">ED</jats:styled-content> for <jats:styled-content style="fixed-case">LBP</jats:styled-content> patients.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A protocol was developed a priori, following the <jats:styled-content style="fixed-case">PRISMA</jats:styled-content> guidelines, and registered with <jats:styled-content style="fixed-case">PROSPERO</jats:styled-content>. Six bibliographic databases (including <jats:styled-content style="fixed-case">MEDLINE</jats:styled-content>,<jats:styled-content style="fixed-case"> EMBASE</jats:styled-content>,<jats:styled-content style="fixed-case"> EBM</jats:styled-content> Reviews, <jats:styled-content style="fixed-case">SCOPUS</jats:styled-content>,<jats:styled-content style="fixed-case"> CINAHL</jats:styled-content>, and Dissertation Abstracts) and the gray literature were searched. Comparative studies assessing interventions that targeted image ordering in the <jats:styled-content style="fixed-case">ED</jats:styled-content> for adult patients with <jats:styled-content style="fixed-case">LBP</jats:styled-content> were eligible for inclusion. Two reviewers independently screened study eligibility and completed data extraction. Study quality was completed independently by two reviewers using the before–after quality assessment checklist, with a third‐party mediator resolving any differences. Due to a limited number of studies and significant heterogeneity, only a descriptive analysis was performed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The search yielded 603 unique citations of which a total of five before–after studies were included. Quality assessment identified potential biases relating to comparability between the pre‐ and postintervention groups, reliable assessment of outcomes, and an overall lack of information on the intervention (i.e., time point, description, intervention data collection). The type of interventions utilized included clinical decision support tools, clinical practice guidelines, a knowledge translation initiative, and multidisciplinary protocols. Overall, four studies reported a decrease in the relative percentage change in imaging in a specific image modality (22.7%–47.4%) following implementation of the interventions; however, one study reported a 35% increase in patient referrals to radiography, while another study reported a subsequent 15.4% increase in referrals to <jats:styled-content style="fixed-case">CT</jats:styled-content> and myelography after implementing an intervention which reduced referrals for simple radiography.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>While imaging of <jats:styled-content style="fixed-case">LBP</jats:styled-content> has been identified as a key area of imaging overuse (e.g., Choosing Wisely recommendation), evidence on interventions to reduce image ordering for <jats:styled-content style="fixed-case">ED</jats:styled-content> patients with <jats:styled-content style="fixed-case">LBP</jats:styled-content> is sparse. There is some evidence to suggest that interventions can reduce the use of simple imaging in <jats:styled-content style="fixed-case">LBP</jats:styled-content> in the <jats:styled-content style="fixed-case">ED</jats:styled-content>; however, a shift in imaging modality has also been demonstrated. Additional studies employing higher‐quality methods and measuring intervention fidelity are strongly recommended to further explore the potential of <jats:styled-content style="fixed-case">ED</jats:styled-content>‐based interventions to reduce image ordering for this patient population.</jats:p></jats:sec>