Letter to the Editor: Impact of COVID-19 Outbreak on Acute Low Back Pain

Borsa, Stefano; Pluderi, Mauro; Carrabba, Giorgio; Ampollini, Antonella; Pirovano, Marta; Lombardi, Fabrizio; Tomei, Massimo; Locatelli, Marco

doi:10.1016/j.wneu.2020.05.218

Cited by 16 publications

(20 citation statements)

References 6 publications

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“… 20 Studies in New South Wales and London also found decline in overall ED presentations for any condition during COVID-19 of around one quarter, similar to what we found for low back pain. 21 , 22 Borsa et al found a much larger reduction in presentations to hospital for low back pain (87%) 12 but this could be explained by the inclusion of outpatient department presentations.…”

Section: Discussionmentioning

confidence: 99%

“…In Milan from March 8, 2020 to April 8, 2020 there was an 87% reduction in patients presenting with acute low back pain to hospitals compared to the same period in 2019. 12 Interestingly, the proportion of people presenting with serious spinal conditions (e.g. cancer, fracture or infection) remained similar in both years, suggesting that the pandemic discouraged ED attendance irrespective of the seriousness of the underlying condition.…”

Section: Introductionmentioning

confidence: 92%

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

Sharma

Traeger

Machado

et al. 2022

Australasian Emergency Care

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

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

Sharma

Traeger

Machado

et al. 2022

Australasian Emergency Care

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“…We experienced a significant decrease in overall neurosurgical admissions, mostly due to reduction of elective cases and emergency admissions, probably supported by an increase in conservative management, patients' fear of going to hospitals seen as a risk of infection, and a reduction of trauma cases due to the national lockdown measures. [18][19][20] The most interesting data from the analysis of our region's neurosurgical departments' activities during March 2020 was the increase (33%) of endovascular procedures for AIS, whereas globally admissions and surgeries/endovascular procedures for hemorrhagic stroke and SAH decreased considerably. Although isolated cases of aneurysmal SAH in SARS-CoV-2-positive patients have been reported, 21 a global reduction of SAH caused by aneurysm rupture was noticed by other authors.…”

Section: Discussionmentioning

confidence: 99%

“…he recent outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (i.e., coronavirus disease 2019 or COVID- 19) spread to pandemic proportions and increased demands and pressure on health systems all over the world. Italy became the epicenter of the epidemic in March 2020, with a toll of 110,574 infected, 13,155 deaths, and 4035 patients occupying intensive care units (ICUs) on April 1, 2020.…”

mentioning

confidence: 99%

Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

Raneri

Rustemi

Zambon

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe purpose of this study was to analyze the effect of the coronavirus disease 2019 (COVID-19) outbreak and of the subsequent lockdown on the neurosurgical services of the Veneto region in Italy compared to the previous 4 years.METHODSA survey was conducted in all 6 neurosurgical departments in the Veneto region to collect data about surgical, inpatient care and endovascular procedures during the month of March for each year from 2016 to 2020. Safety measures to avoid infection from SARS-CoV-2 and any COVID-19 cases reported among neurosurgical patients or staff members were considered.RESULTSThe mean number of neurosurgical admissions for the month of March over the 2016–2019 period was 663, whereas in March 2020 admissions decreased by 42%. Emergency admissions decreased by 23%. The average number of neurosurgical procedures was 697, and declined by 30% (range −10% to −51% in individual centers). Emergency procedures decreased in the same period by 23%. Subarachnoid hemorrhage and spontaneous intracerebral hemorrhage both decreased in Veneto—by 25% and 22%, respectively. Coiling for unruptured aneurysm, coiling for ruptured aneurysm, and surgery for ruptured aneurysm or arteriovenous malformation diminished by 49%, 27%, and 78%, respectively. Endovascular procedures for acute ischemic stroke (AIS) increased by 33% in 2020 (28 procedures in total). There was a slight decrease (8%) in brain tumor surgeries. Neurosurgical admissions decreased by 25% and 35% for head trauma and spinal trauma, respectively, while surgical procedures for head trauma diminished by 19% and procedures for spinal trauma declined by 26%. Admissions and surgical treatments for degenerative spine were halved. Eleven healthcare workers and 8 patients were infected in the acute phase of the pandemic.CONCLUSIONSThis multicenter study describes the effects of a COVID-19 outbreak on neurosurgical activities in a vast region in Italy. Remodulation of neurosurgical activities has resulted in a significant reduction of elective and emergency surgeries compared to previous years. Most likely this is a combined result of cancellation of elective and postponable surgeries, increase of conservative management, increase in social restrictions, and in patients’ fear of accessing hospitals. Curiously, only endovascular procedures for AIS have increased, possibly due to reduced physical activity or increased thrombosis in SARS-CoV-2. The confounding effect of thrombectomy increase over time cannot be excluded. No conclusion can be drawn on AIS incidence. Active monitoring with nasopharyngeal swabs, wearing face masks, and using separate pathways for infected patients reduce the risk of infection.

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“…LBP has an incidence of about 5% per year and accounts for about 3% of emergency department visits in the United States [5]. Although the current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has reduced healthcare care visits and treatment of patients with acute LBP (reduction by 87.2%) for several reasons [5,6], back pain is still a growing medical and socio-economic problem [7]. It is estimated that more than a third of occupational diseases in the Nordic countries, the United States, and Japan are associated with the musculoskeletal system, and LBP has been identified as the leading cause of sick leave [8,9].…”

Section: Introductionmentioning

confidence: 99%

Low back pain among health workers

Lacokova-Krasnikova¹,

Dimitrov²,

Krasnik

et al. 2020

Med pregl

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Introduction. Back pain is often present among health workers. The aim of the study was to determine the impact of gender and years of work experience on the incidence of low back pain. Material and Methods. A prospective cross-sectional study included 67 subjects of both genders, and it was conducted in the period between June 1 and 15, 2020, in two health centers in Serbia. The impact of gender, age, years of work experience on the incidence of low back pain was analyzed, measured by the Roland-Morris disability questionnaire. Results. In the examined sample (n = 67), the majority were females (55, 82.1%). The average age of the respondents was 45.5 ? 12.2 years, with an average work experience of 20.62 ? 12.03 years. Low back pain was present in 35 subjects (52.2%). There was no statistically significant difference between male and female subjects regarding the Roland-Morris disability score (3.83 ? 4.50 vs. 4.96 ? 4.53; p > 0.05). There was a statistically significant positive correlation between the age of subjects and the Roland-Morris disability score (r = 0.407; p < 0.01). Subjects with more years of work experience presented with a higher Roland-Morris disability score (r = 0.371; p < 0.01). Conclusion. Low back pain is common in older health workers with longer work experience, regardless of the level of formal education. Additional education of health workers on the application of protective attitudes, movements, and exercise, is needed in order to prevent the development of low back pain in the work environment.

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Letter to the Editor: Impact of COVID-19 Outbreak on Acute Low Back Pain

Cited by 16 publications

References 6 publications

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

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

Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

Low back pain among health workers

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