Summary: For patients 65 or older with a new episode of back pain and no “red flags”, delaying imaging until at least 4 to 6 weeks after symptom onset is not associated with any worse clinical outcomes, but is associated with significantly lower resource use and costs (potential “red flags” that may warrant earlier imaging include risk factors for cancer, cauda equina syndrome or severe neurologic deficits, and fever with a history of IV drug use or recent infection).

Strength of Recommendation = B