MRI Order Appropriateness for Chronic Neck Pain: Comparison of Ordering Practices and Treatment Outcomes for Primary Care Physicians and Specialists.

Chronic neck pain is a common reasons for doctor visits in the U.S. This diagnosis can be evaluated through patient history, physical examination and judicious use of radiographs. However, possible inappropriate magnetic resonance imaging ordering persists. We hypothesized that no difference in ordering practices, ordering appropriateness and subsequent intervention would be appreciated regarding physician specialty, location, patient characteristics, and history and physical exam findings. A multisite retrospective review for cervical spine MRIs between 2014 and 2018 was performed. A total of 332 patients were included. Statistical analysis was used to assess MRI order appropriateness, detail of history and physical exam findings and intervention decision making among different specialties. If significant differences were found, multiple linear regression was performed to evaluate the association of MRI order appropriateness regarding physician specialty, location, patient characteristics and history and physical exam findings. Significance level for all tests was set at <0.05 Orthopaedic surgeons ordered MRIs most appropriately with an average ACR score of 8.4 (p<0.005). Orthopaedic surgeons had more comprehensive physical exams as compared to remaining specialties. Decision for intervention did not vary by physician specialty or ACR score, except for patients of pain medicine physicians who received pain management (p=0.000). Orthopaedic surgeons utilize MRI most appropriately and have more comprehensive physical exams. These findings suggest a need for increased physician education on what indicates an appropriate MRI order to improve the use of resources and further protect patient risk-benefit profiles. Further research elucidating factors to minimize negative findings in "appropriate" MRIs is indicated. This article is protected by copyright. All rights reserved.