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Most clinical guidelines discourage early radiologic imaging for nonspecific back pain, but this recommendation is based mostly on studies in younger patients. Many guidelines allow for early imaging in older patients because of their higher prevalence of serious underlying conditions. However, older patients are more likely to have incidental findings that might stimulate unnecessary evaluations.
In this prospective cohort study, 1174 older adults (mean age, 74; 65% women) with new episodes of back pain who received plain radiography within 6 weeks of onset of pain were matched on demographic and clinical factors with 1174 patients who did not undergo early imaging. Similar matching was performed for 349 patients who received early magnetic…