LAUSR

BACKGROUND Low back pain (LBP) is increasingly burdening the pediatric population. Advanced imaging such as computerized tomography (CT) scans and magnetic resonance imaging (MRIs) associated with LBP impose significant costs with little benefit. We investigated annual trends and demographic/geographic variation in spinal imaging for first time pediatric presenters of LBP in primary care clinics. METHODS We queried a private administrative claims database for patients presenting with LBP who underwent plain radiographs, CT scans, and MRIs from 2011 to 2017. We used a Cochrane Armitage test of trend to determine significant annual variation in diagnostic imaging utilization during the study period. To determine demographic and geographic variation, chi-squared tests were performed. RESULTS 67,423 patients were included, with mean age 15.2 ± 3 years. There was no significant change in radiograph use (34.8% in 2011 vs. 35.5% in 2017, p=0.795) or CT scans (1.6% in 2011 vs. 1.1% in 2017, p=0.073), but a significant increase in MRIs (3.3% in 2011 vs. 4.5% in 2017, p=0.017). Overall, there was no significant change in total imaging use (p=0.895). Males had higher rates of imaging compared to females (40.2% vs. 35.6%, p<0.001). Imaging rates significantly varied between regions and states across the United States (p<0.001). The Midwest had the highest imaging rates (41%), while the Northeast had the lowest (31%). CONCLUSIONS There was significant demographic and geographic variation but no significant annual change in total diagnostic spinal imaging for pediatric patients with LBP between 2011 and 2017, with rates of advanced imaging remaining relatively low.