Low back pain presentations to rural, regional, and metropolitan emergency departments

Davidson, Simon; Kamper, Steven J; Haskins, Robin; O'Flynn, Michael; Coss, Karen P.; Smiles, J.; Tutty, Amanda; Linton, Jane; Bryant, Joe; Buchanan, Maree; Williams, Christopher M.

doi:10.1111/ajr.12854

Cited by 6 publications

(12 citation statements)

References 26 publications

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“…The pooled prevalence estimate for adults presenting to an emergency setting with low back pain is 4.39% (95% CI: 3.67–5.18) of all visits [ 10 ]. Re-presentations to a hospital emergency department (ED) for treatment of LBP is also common, with re-presentation rates within major cities 6%, inner regional EDs 8.8% and outer regional Eds 11.8% [ 11 ]. Management of LBP patients in the ED setting includes high rates of opioid analgesic use (69.6%), lumbar imaging (23.6%) and hospital admissions (17.6%) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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)

et al. 2023

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Background In Australian emergency departments, 30% of all back pain presentations are for older adults. Relatively little is known about the care that this population receives during an emergency department stay, including admission to hospital. The aim of this study is to describe emergency department management of older adults diagnosed with a lumbar spine condition and to determine predictors of healthcare use in this population. Methods A retrospective analysis of electronic medical record data of adults aged ≥ 65 years with a lumbar spine discharge diagnosis. Demographic, clinical care (date and time of presentation and discharge, length of stay in the emergency department, mode of arrival, triage category, re-presentations to the emergency department (within 48 h), discharge mode, the administration of pain-relieving medicines, lumbar imaging, and laboratory tests) and costs data were extracted from the electronic medical record system. Descriptive analyses and multilevel mixed-effects logistic regression models were performed. Results Over the period January 2016 to December 2019 there were 4,093 presentations to emergency departments by older adults with a lumbar spine discharge diagnosis (82.0% were non-specific low back pain). Most were female (58.3%), 39.9% had some form of lumbar imaging, and 34.1% were admitted to hospital. The most administered pain medicines were opioid analgesics (67.1%), followed by paracetamol (63.9%) and NSAIDs (33.0%). Predictors of healthcare use and hospital inpatient admission were receiving a laboratory test and receiving any opioid. For the financial period 2019-20, the mean (SD) total cost of care per presentation was $5,629 ($11,982). Conclusion In the emergency department, more than two thirds of older adults with a lumbar spine condition received opioid analgesics. They often received imaging and laboratory tests, had high costs and were admitted to hospital. Alternative pathways of care are needed to support older adults with low back pain, to receive guideline-concordant emergency department care and have good health outcomes.

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Section: Introductionmentioning

confidence: 99%

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)

et al. 2023

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“…All except two Spanish publications were available in English. Data on patient ethnicity (two studies),11 18 socioeconomic status (one study)11 or type of admitting hospital unit (four studies)9 19 40 41 was scarce.…”

Section: Resultsmentioning

confidence: 99%

“…We analysed the proportion of low back pain admissions from ED from 3 government reports25 28 43 and 20 peer-reviewed studies14 16–19 40 42–56 (table 1). Seven studies were from healthcare systems with predominantly private funding, 16 with predominantly public funding.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies were excluded from the figure due to variation in low back pain definition and/or year of data collection, as well as not being representative country level data. Australian retrospective observational studies indicate a mean hospital LOS ranging from 4 to 6 days9 16 48 for mixed low back and radicular pain, and 2 days (IQR 1–5)18 for non-specific low back pain only. Similarly, a study on admission for dorsalgia in England4 found a LOS of 2.7 days in 2014.…”

Section: Resultsmentioning

confidence: 99%

“…Hospital length of stay (LOS) for those admitted primarily for low back pain has not been well explored across different countries. There appears to be significant variation in LOS, ranging from a median of 2-day stay for non-specific low back pain in New South Wales, Australia18 to 15.3 days for lumbago in Udine, Italy 19. Another way of examining global clinical variation is to consider low back pain hospital admissions standardised per 100 000 population, to allow direct comparison between countries 20 21.…”

Section: Introductionmentioning

confidence: 99%

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Global prevalence of hospital admissions for low back pain: a systematic review with meta-analysis

et al. 2023

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ObjectivesTo determine the proportion of low back pain presentations that are admitted to hospital from the emergency department (ED), the proportion of hospital admissions due to a primary diagnosis of low back pain and the mean hospital length of stay (LOS), globally.MethodsWe searched MEDLINE, CINAHL, EMBASE, Web of Science, PsycINFO and LILACS from inception to July 2022. Secondary data were retrieved from publicly available government agency publications and international databases. Studies investigating admitted patients aged >18 years with a primary diagnosis of musculoskeletal low back pain and/or lumbosacral radicular pain were included.ResultsThere was high heterogeneity in admission rates for low back pain from the ED, with a median of 9.6% (IQR 3.3–25.2; 9 countries). The median percentage of all hospital admissions that were due to low back pain was 0.9% (IQR 0.6–1.5; 30 countries). The median hospital LOS across 39 countries was 6.2 days for ‘dorsalgia’ (IQR 4.4–8.6) and 5.4 days for ‘intervertebral disc disorders’ (IQR 4.1–8.4). Low back pain admissions per 100 000 population had a median of 159.1 (IQR 82.6–313.8). The overall quality of the evidence was moderate.ConclusionThis is the first systematic review with meta-analysis summarising the global prevalence of hospital admissions and hospital LOS for low back pain. There was relatively sparse data from rural and regional regions and low-income countries, as well as high heterogeneity in the results.

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Emergency department length of stay and re-presentation rates in patients with low back pain: A medical record review study

Xu,

Chen,

Oliveira

et al. 2024

The American Journal of Emergency Medicine

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Low back pain presentations to rural, regional, and metropolitan emergency departments

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 6 publications

References 26 publications

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)

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)

Global prevalence of hospital admissions for low back pain: a systematic review with meta-analysis

Emergency department length of stay and re-presentation rates in patients with low back pain: A medical record review study

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