Quality statement 2: Referrals for imaging

Quality statement

Young people and adults with low back pain with or without sciatica do not have imaging requested by a non-specialist service unless serious underlying pathology is suspected.

Rationale

Imaging does not often change the initial management and outcomes of someone with back pain. This is because the reported imaging findings are usually common and not necessarily related to the person's symptoms. Many of the imaging findings (for example, disc and joint degeneration) are frequently found in asymptomatic people. Requests for imaging by non-specialist clinicians, where there is no suspicion of serious underlying pathology, can cause unnecessary distress and lead to further referrals for findings that are not clinically relevant.

Quality measures

Structure

a) Evidence of local arrangements for young people and adults with low back pain with or without sciatica to be referred for specialist opinion.

Data source: Local data collection, for example, service protocols.

b) Evidence of local protocols outlining serious underlying pathology in relation to presentations of low back pain with or without sciatica.

Data source: Local data collection, for example, service protocols.

Process

Proportion of young people and adults with low back pain with or without sciatica who have imaging requested by a non-specialist service when no serious underlying pathology is suspected.

Numerator – the number in the denominator who have imaging requested by a non-specialist service.

Denominator – the number of young people and adults with low back pain with or without sciatica for whom there is no suspicion of serious underlying pathology.

Data source: Local data collection, for example, patient notes.

What the quality statement means for different audiences

Service providers (non-specialist services) ensure that staff are aware of and use local referral pathways to specialist services and do not request imaging for young people and adults with low back pain with or without sciatica unless serious underlying pathology is suspected.

Healthcare professionals (such as GPs and nurses) do not request imaging within a non-specialist service for young people and adults with low back pain with or without sciatica unless serious underlying pathology is suspected. Healthcare professionals should explain to young people and adults who are referred for a specialist opinion that they may not need imaging.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission specialist services with clinicians who have the expertise to make a decision about whether young people and adults with low back pain with or without sciatica should have imaging and that these services accept referrals from non-specialist services.

Young people and adults with low back pain with or without sciatica do not have imaging requested by a non-specialist service (such as a GP practice) unless serious underlying disease is suspected.

Source guidance

Low back pain and sciatica in over 16s (2016) NICE guideline NG59, recommendations 1.1.1 and 1.1.4.

Definitions of terms used in this quality statement

Non-specialist service

Services such as a GP practice in primary care.

[Expert opinion]

Serious underlying pathology

Example of serious underlying pathology include but are not limited to: cancer, infection, trauma or inflammatory disease such as spondyloarthritis. If serious underlying pathology is suspected, refer to relevant NICE guidance on:

[Adapted from NICE's guideline on low back pain and sciatica in over 16s, recommendation 1.1.1]