| Clinical features and settings |
Patients seeking treatment at a walk‐in clinic (USA), with back pain as their primary complaint. 72% with LBP duration less than 1 month; first medical care for back pain in 53%. |
| Participants |
The history and physical examination was completed for 1108 patients. 487 were excluded for the following reasons: 187 had maximal pain above T12; 79 had evidence of urinary tract disease; 131 were women less than 45 years old who were not practising contraception and had not had a menstrual period within 10 days; 130 were participants in a clinical trial which constrained x‐ray ordering; and 37 had unlocated x‐ray or laboratory results (some patients had more than one exclusion criterion). The study sample was of 621 patients with mean age of 40.5 years (range 15‐86 years). |
| Study design |
Prospective longitudinal study examining actual x‐ray utilisation, and assessing the potential effects of applying selective criteria for x‐ray utilisation. |
| Target condition and reference standard(s) |
The hospital tumour registry and discharge records were used to identify patients found to have a malignancy during the six months after the initial visit, and the medical records of all febrile patients were reviewed after six months. Four cases (0.64%) of malignancy were identified. |
| Index and comparator tests |
History and physical examination data (65 items) were recorded by physicians on a standard coding form. Data available only on two index tests: patient aged > 50 years; and not improved after 1 month. |
| Follow‐up |
Missing or uninterpretable data not reported. |
| Notes |
|
| Table of Methodological Quality |
| Item |
Authors' judgement |
Description |
| Representative spectrum?
All tests |
Yes |
Consecutive series of patients with low‐back pain |
| Acceptable reference standard?
All tests |
Yes |
X‐ray ‐ anteroposterior and lateral lumbar views |
| Acceptable delay between tests?
All tests |
Yes |
84% of reference test obtained on the day of the index test or within 6 days thereafter |
| Partial verification avoided?
All tests |
No |
Only 311 of 621 received the x‐ray reference test |
| Differential verification avoided?
All tests |
Unclear |
Unclear from text |
| Incorporation avoided?
All tests |
Yes |
X‐ray not part of index tests |
| Reference standard results blinded?
All tests |
Unclear |
Unclear from text |
| Index test results blinded?
All tests |
Unclear |
Unclear from text |
| Relevant clinical information?
All tests |
Yes |
Index tests available in usual care |
| Uninterpretable results reported?
All tests |
No |
Not reported |
| Withdrawals explained?
All tests |
Unclear |
Unclear from text |
