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Association of magnetic resonance imaging for back pain on seven-day return visit to the Emergency Department
  1. Emily L Aaronson1,2,
  2. Brian J Yun1,
  3. Elizabeth Mort2,3,
  4. David Brown1,
  5. Ali S Raja1,
  6. Haytham M A Kaafarani4,
  7. Yuchiao Chang3,
  8. Jarone Lee1,4
  1. 1 Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians’ Organization, Boston, Massachusetts, USA
  3. 3 Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Jarone Lee, Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, Zero Emerson Place, Suite 3B, Boston, MA 02115, USA; lee.jarone{at}


Background The prevalence of back pain is rising, as is the use of high-cost imaging in the ED. The objective of our study was to determine if an MRI in the ED for patients with back pain resulted in a lower incidence of ED return visit and to determine if these patients had longer ED length of stay (LOS) and use of ED observation.

Methods A retrospective cohort study of consecutive patients seen with back pain was conducted at an urban, university-affiliated ED between 1 January 2012 and 11 July 2014. The association of MRI on return within 7 days was assessed using a χ2 test and a multivariable logistic regression model and the difference in median ED LOS was compared using a Wilcoxon rank-sum test.

Results During the study period, 6094 patients were evaluated in the ED with back pain as the primary diagnosis. Of these, 797 (13%) received an MRI. Among all patients with back pain, 277 (4.5%) returned within 7 days. Univariate analysis found that patients who received an MRI were no less likely to return within 7 days than patients who did not (4.3% vs 4.6%; p=0.68). Patients who had an MRI were more likely to be admitted to observation (74.2% vs 10.8%; p<0.0001) and had a longer ED LOS (median 4.8 hours vs 2.7; p<0.0001). Multivariable regression confirmed that MRI did not decrease the rate of a 7-day return visit (OR=0.98; 95% CI 0.68 to 1.42).

Conclusions In patients with uncomplicated back pain, performing an MRI will not mitigate their likelihood of return; however, it leads to a longer ED LOS and more ED observation admissions.

  • imaging, CT/MRI
  • Emergency Department utilisation
  • quality
  • cost- effectiveness
  • musculoskeletal

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  • Contributors All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline. To the best of our knowledge, no conflict of interest, financial or other, exists.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.