Unfortunately, not all new patient presentations are straight-forward. Some have holes in their stories, or the evaluation doesn’t match the history. Frequently, there are additional questions that need to be answered through diagnostic tests, blood work, imaging, or record reviews. If we don’t gather all of the correct information and arrive at the right diagnosis, both you and your patient leave with an uneasy lasting impression.
Watch Dr. Steele explain new research regarding the current standard of care for diagnostic imaging.
Evidence-based chiropractors pride themselves on being efficient, effective, and following clinical practice guidelines.
Imaging is not intended to diagnose a patient; instead, it should be used to rule in or rule out differential considerations. The use of clinical prediction rules and diagnostic clusters yield stronger diagnoses: many times with the same specificity and sensitivity of imaging. When orthopedic tests are inconclusive, the history and mechanism of injury don’t add up, or there are red flags present, we must consider imaging to gather additional information.
A recent study by Jenkins et al. (2018) Found that imaging was inappropriately ORDERED or NOT ORDERED at alarming rates. That’s right! In fact, physicians not only order imaging on people who don’t need it, but they don’t order imaging on the patients who do. Let’s examine these findings and consider solutions you can make today to protect your patients, and yourself.
Solution 1: For a list of red flags and imaging recommendations, refer to the CONDITION REFERENCE section in ChiroUp and select your primary diagnosis. (Imaging recommendations are regularly updated and reviewed by DACBR chiropractors.)
Solution 2: Patients often respond well to care and show continual improvement in their subjective and objective findings. If a patient is not meeting treatment goals or shows frequent relapses—imaging may be necessary. Most peer-reviewed recommendations and insurance carriers cite 4-6 weeks of care before imaging. If your clinical suspicion is high, never shy away from digging deeper sooner with imaging or other diagnostic tests.
Solution 3: Don’t dig your head in the sand and shun imaging in every case. In this study, over 60% of people with red flags or suspicious exam findings didn’t get imaged. Considered imaging for acute low back pain when there is clinical suspicion of severe pathology or surgery is being considered to address a specific pathology. The prevalence of threatening pathologies such as an infection or tumor is estimated to be the cause of LBP in less than 1% and 10% of presentations respectively. Editing your review of systems and exam forms to ask the rights questions or perform the right tests will also help in your diagnostic process.
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Jenkins HJ, et al. Imaging for low back pain: is clinical use consistent with guidelines? A systematic review and meta-analysis The Spine Journal 2018
About the Author
Dr. Brandon Steele
DC, DACODr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.