As per the findings of a recently published systematic review and meta-analysis in the British Journal of Sports Medicine, High-quality pieces of evidence were found in the context of imaged people who were presented to the emergency. This analysis conducted to assess (a) the subjects seeking care for low back pain (LBP) who were imaged (b) trends in the patients who underwent diagnostic imaging over time.

The impact of study-level factors on measures of imaging proportion was also assessed. CINAHL, MEDLINE, and Embase were searched from January 1995 to December 2017 and selected the observational designs and controlled trials which described imaging for cases presenting to emergency care or primary care for LBP. Using care setting and imaging type, study quality was estimated, and pooled proportions were measured. The evidence strength was evaluated using the GRADE system.

A total of 45 studies were selected with 4 343 919 imaging requests/events over 21 years. Moderate quality evidence indicated that simple imaging proportion was 16.3% and complex imaging proportion was 9.2% in the settings of primary care. For any imaging, 24.8% pooled proportion was found. In emergency care, moderate quality evidence indicated that simple imaging proportion was 26.1% and high-quality evidence indicated that complex imaging proportion was 8.2%. The pooled proportion for any imaging found was 35.6%. An increase of about 50% was observed in complex imaging from 1995-2015. Further, the study-level characteristics explained the between-study variability in imaging proportions on a partial basis. However, to describe some prespecified study-level factors, data was insufficient. These outcomes bring attention to high levels of imaging in both care settings.