Urgent Care Radiography for Low Back Pain Is Rarely Followed by Emergency Advanced Imaging

Workup of low back pain (LBP) in emergency departments (EDs) commonly involves CT or MRI, even though guidelines reserve advanced imaging for patients with red flags. We measured how often urgent care center (UCC) radiography for low-acuity LBP was followed by advanced imaging in the ED within 30 days, and compared per-study resource intensity between UCC radiography and ED CT or MRI.

This retrospective cohort study included adults imaged for LBP at 23 UCCs and affiliated EDs between 2019 and 2025. We excluded red-flag presentations by screening keywords from the order indication. We identified 30-day returns by linking medical record numbers between cohorts, and two radiologists reviewed each one. Resource intensity was measured as Total Relative Value Units (RVU) per study, converted to approximate Medicare-allowed dollars.

Among 16,754 studies (2,924 UCC radiographs, 13,830 ED studies) from 15,759 patients, UCC patients were younger (median 50 vs 67 years, P < 0.001). Median Total RVU was 1.43 (UCC) versus 5.14 (ED) (about $48 vs $171, P < 0.001). Twenty-four UCC studies were followed by ED advanced imaging within 30 days (0.82%, 95% CI 0.55-1.22), 12 within 24 hours. Radiologists judged one return a true radiographic miss. Return rates were similar across UCC networks (P = 1.00).

UCC radiography for low-acuity LBP was rarely followed by ED advanced imaging within 30 days and entailed lower per-study imaging resource use than ED CT or MRI.