Management of patients presenting with low back pain to a private hospital emergency department in Melbourne, Australia

Abstract

Objective: Recent studies suggest many patients with non-specific low back pain presenting to public hospital EDs receive low-value care. The primary aim was to describe management of patients presenting with low back pain to the ED of a private hospital in Melbourne, Australia, and received a final ED diagnosis of non-specific low back pain. We also determined predictors of hospital admission. Methods: Retrospective review of patients who presented with low back pain and received a final ED diagnosis of non-specific low back pain to Cabrini Malvern ED in 2015. Demographics, lumbar spinal imaging, pathology tests and medications were extracted from hospital records. Multivariate logistic regression was used to determine independent predictors of hospital admission. Results: Four hundred and fifty presentations were included (60% female); 238 (52.9%) were admitted to hospital. One hundred and seventy-seven (39.3%) patients received lumbar spine imaging. Two hundred and eighty (62.2%) patients had pathology tests and 391 (86.9%) received medications, which included opioids (n = 298, 66.2%), paracetamol (n = 219, 48.7%), NSAIDs (n = 161, 35.8%), benzodiazepines (n = 118, 26.2%) and pregabalin (n = 26, 5.8%). Predictors of hospital admission included older age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.02-1.05), arrival by ambulance (OR 2.03, 95% CI 1.06-3.90) and receipt of pathology tests (OR 3.32, 95% CI 2.01-5.49) or computed tomography scans (OR 1.86,. Conclusion: We observed high rates of imaging, pathology tests and hospital admissions compared with previous public hospital studies, while medication use was similar. Implementation of strategies to optimise evidence-based ED care is needed to reduce low-value care and improve patient outcomes.

Paramedic management of back pain: a scoping review

“…These back pain presentations via ambulance are an average of AUD$449 more costly to the hospital system when a patient is discharged, and an average of AUD$1,812 more costly when a patient is admitted to hospital, compared to non-ambulance presentations [6]. Interestingly, these presentations are less likely to be triaged as 'emergency' or 'urgent' patients compared to those who arrived using other modes [5].…”

“…For example, back pain presentations that arrive by ambulance are more likely to receive lumbar imaging, opioid medications and hospital admission regardless of hospital setting (e.g. public or private hospital) [3,5]. These back pain presentations via ambulance are an average of AUD$449 more costly to the hospital system when a patient is discharged, and an average of AUD$1,812 more costly when a patient is admitted to hospital, compared to non-ambulance presentations [6].…”

Adverse outcomes following the provision of opioid therapy for musculoskeletal pain in the emergency department: a systematic review and meta-analysis protocol

“…4,5 Despite the recommendation from clinical guidelines, recent studies in Australian EDs found that opioids were administered to 55% of patients with non-traumatic musculoskeletal pain and nearly 70% of patients with low back pain. [6][7][8] Oxycodone alone was provided to 57% of patients presenting to Australian EDs with low back pain. 7…”

“…4,5 Despite the recommendation from clinical guidelines, recent studies in Australian EDs found that opioids were administered to 55% of patients with non-traumatic musculoskeletal pain and nearly 70% of patients with low back pain. [6][7][8] Oxycodone alone was provided to 57% of patients presenting to Australian EDs with low back pain. 7Adverse outcomes related to opioid therapy for pain management have been reported in the literature.Recent studies showed that opioid-naïve patients with low back pain who were administered or prescribed opioid in the ED were more likely to have continued opioid use at six-months after the index ED visit.…”

Low Back Pain Patient Distribution in Malang's Secondary Referral Private Hospital: A Single-Center Study

“…2 Low back pain was the sixth most prevalent primary diagnosis for visiting a public hospital in Australia in 2017-2018. 3 Physical, occupational, and psychosocial all have a role in LBP risk factors. People with physically demanding employment, physical and mental illnesses, smokers, and obese people are more likely to experience low back discomfort.…”