Effect of COVID-19 on management of patients with low back pain in the emergency department

Abstract

Background Patients presenting to Emergency Department (ED) with non-specific low back pain can receive more unnecessary, intensive and costly care than is recommended. The COVID-19 pandemic has provided an unprecedented opportunity to examine how health systems prioritise necessary care that provides clear benefits to patients. The purpose of this study was to examine the impact of COVID-19 on care of low back pain in the ED. Methods We performed a retrospective analysis of electronic medical record data on care for low back pain from three public hospitals in Sydney. We included patients diagnosed with spinal conditions who presented between March and May in 2019 and in 2020. Outcomes were the total number of patients presenting with spinal conditions to ED, the proportion diagnosed with non-specific low back pain, and the proportion receiving potentially unnecessary aspects of care (ambulance use, imaging, opioids, hospital admissions). We calculated relative risk with 95% CIs and examined plots with locally weighted smoothed curves. Results Presentations for spinal conditions over a three-month period to three EDs reduced from 694 in 2019 to 475 in 2020 (31% reduction, 95% CI = 26% to 37%). The proportion of patients diagnosed with non-specific low back pain (83% in 2019 vs 86% in 2020), or receiving potentially unnecessary care were similar in 2019 and 2020 (Imaging = 25% vs 25%; Opioids = 54% vs 56%; Admitted = 18% vs 20%; pathology test = 24% vs 23%). The proportion of patients arriving by ambulance was higher during the pandemic; 29% in 2019 vs 41% in 2020 (RR = 1.39, 95% CI = 1.19 to 1.63). Conclusions ED presentations for low back pain associated with spinal conditions decreased substantially during the COVID-19 pandemic. Use of potentially unnecessary aspects of care did not change or increased during the pandemic.

Trends in low-value GP care during the COVID-19 pandemic: a retrospective cohort study

“…Our findings regarding the observed differences in both trends in episodes [ 47 – 51 ] and low-value services are in line with previous studies in hospital care [ 27 , 52 – 54 ]. Hence, both the number and rates of episodes and low-value care provision were largely affected during the first months of the COVID-19 pandemic.…”

Australian emergency department care for older adults diagnosed with low back pain of lumbar spine origin: a retrospective analysis of electronic medical record system data (2016–2019)

“…Data analysed were collected for all LBP presentations to the emergency departments from hospitals' electronic medical record systems between January 2016 to December 2019, with costs data extracted from the 2019/2020 financial year. While there was a decrease in the number of emergency department presentations of LBP during the COVID-19 pandemic, unnecessary aspects of emergency department care did not change, and therefore data collected during this time should not skew results [24]. A key strength of this study lies within the large, real world sample of older adults diagnosed at discharge with a lumbar spine condition in the emergency department (n = 4,093).…”

COVID-19 Pandemic Increases the Impact of Low Back Pain: A Systematic Review and Metanalysis

“…After further excluding 147 studies, 16 papers were read in full text. Subsequently, eight manuscripts were excluded for the following reasons: mainly focused on physical activity (n = 2) [2,26], patients with LBP in the emergency department (n = 1) [27], clinical presentations of pain (n = 1) [28], expected impact of lockdown measures on LBP (n = 1) [29], mainly focused on loneliness and social isolation (n = 2) [30,31], evaluation of an intervention for LBP (n = 1) [32]. Finally, eight studies were included in the systematic review and meta-analysis (Figure 1).…”