Imaging Adolescents

“No Imaging Needed For Most Low Back Pain”
http://www.medscape.com/viewarticle/752771

From the American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition and research of Denis Drummond, MD the following facts on back pain and imaging of adolescents:

  • mechanical low back pain is common in the pediatric population
  • recent studies have shown that undiagnosable mechanical low back pain accounts for up to 78% of cases in adolescents (we can’t always identify the exact cause, this is true in adults in 85% of cases per Deyo & Weinstein in 2001 in the New England Journal of Medicine) 
  • a child absorbs more radiation and their metabolism is much greater than an adult’s (radiation is likely more harmful to young)
  • attempt conservative management first. After 6 weeks a 50+% improvement should be seen, if so continue with conservative care.  If not, imaging and further investigation is warranted.

Most of these recommendations are not dissimilar from adult clinical guidelines and best practices.  While back pain in children is concerning, we must remember it is not uncommon and is often treated successfully with conservative care allowing us to avoid radiation.  The other aspect is the limited value of imaging as noted in “Is Your Telephone Ringing“.  This is not to say that at times imaging isn’t necessary and appropriate.  Imaging should be used in cases of significant trauma or abnormal presentations to evaluate for conditions such as: fracture, dislocation, infection, tumor, cauda equina syndrome, or with stress views to assess joint instability.

Appropriate and judicious use of imaging controls costs and avoids risks of unnecessary testing, treatment, and radiation.