Outcomes of patients admitted to hospital medical units with back pain

Kyi, L.; Kandane‐Rathnayake, Rangi; Morand, Eric F; Roberts, Lynden

doi:10.1111/imj.14075

Cited by 21 publications

(22 citation statements)

References 10 publications

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“… 20 Others have found decrease in hospital admission for conditions including stroke and myocardial infarction. 2 , 22 We found no change in the proportion admitted which could be explained by the nature of admissions for spinal conditions; many admissions could be considered ‘avoidable.’ 23 Surprisingly however, we did not observe a reduction in the proportion of admissions for back pain even during a period when hospitals were under pressure from COVID-19.…”

Section: Discussioncontrasting

confidence: 68%

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: Discussioncontrasting

confidence: 68%

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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“…Kyi L et al, 17 in their analysis of a group of 712 inpatients with a mean age of 67 years, reported prednisolone, opioid, and neuropathic pain medication use rates of 32%, 97%, and 53%, respectively. The same authors were able to verify image examination use rates of 73%, 21%, and 15% for magnetic resonance, simple radiographs, and CT scans, respectively.…”

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of Patients With Low Back Pain in the Emergency Department

Rodrigues¹,

Siqueira²,

Brito³

et al. 2020

Coluna/Columna

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Objective To describe the daily practice in an emergency service and to provide relevant data for future studies about the treatment of low back pain from the perspective of emergency medicine. Methods Analysis of hospital records and review of medical records. Results 2,434 patients were attended between January 1 and December 31, 2017 with the complaint of low back pain. Radiographs of the spine were performed in 15.7% of patients and computerized tomography scans in 7.6%. Eighty-five patients required hospitalization, with a mean hospital stay of 8.3 days. The rate of use was 52.7% for tricyclic or antiepileptic drugs and 12% for strong opioids among hospitalized patients. Conclusions A high prevalence of low back complaints was observed in the emergency care service (4.6% of total emergency room visits during the year), with low hospitalization potential. The rates of hospitalization and tomographic examinations were higher than those observed in similar studies, with a lower proportion of radiograph and strong opioid use as compared with the same studies. The paucity of national and international data for more in-depth comparisons makes clear the need for further studies and development of new recommendations specifically targeting this subset of patients. Level of evidence IV; Prognostic studies.

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“…Results indicate that patients with LBP admitted to general medicine units stayed longer in hospital than those admitted to specialized rheumatology units [8]. Furthermore, Kyi et al (2019) found that being a woman, aged ≥ 60 years, presence of comorbidities and a diagnosis of canal stenosis or a disc-related diagnosis were signi cantly associated with prolonged LoS (>4 days) [8]. To date, it is unclear to what extent psychological factors associated with LBP have an impact on LoS.…”

Section: Introductionmentioning

confidence: 99%

Influence of Weekday of Admission and Level of Distress on Length of Hospital Stay in Patients With Low Back Pain: A Retrospective Cohort Study

Brunner

Meichtry

Vancampfort

et al. 2020

Preprint

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BackgroundLow back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients’ multidimensional needs. The inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during the weekend. Delays in therapeutic procedures may result in prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates which influence the weekday of admission and distress have on LoS of inpatients with LBP.MethodsRetrospective cohort study conducted between 1 February 2019 and 31 January 2020. ANOVA was used to test the hypothesized difference in mean effects of the weekday of admission on LoS. Further, a linear model was fitted for LoS with distress, categorical weekday of admission (Friday/Saturday vs. Sunday-Thursday), and their interactions.ResultsWe identified 173 patients with LBP. Mean LoS was 7.8 days (SD=5.59). Patients admitted on Friday (mean LoS=10.3) and Saturday (LoS=10.6) had longer stays but not those admitted on Sunday (LoS=7.1). Analysis of the weekday effect (Friday/Saturday vs. Sunday-Thursday) showed that admission on Friday or Saturday was associated with significant increase in LoS compared to admission on other weekdays (t=3.43, p=<0.001). 101 patients (58%) returned questionnaires, and complete data on distress was available from 86 patients (49%). According to a linear model for LoS, the effect of distress on LoS was significantly modified (t=2.51, p=0.014) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday).ConclusionsPatients with LBP are hospitalized significantly longer if they have to wait more than two days for interdisciplinary LBP management. This particularly affects patients reporting high distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients’ multidimensional needs reduces LoS in primary care hospitals.

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Outcomes of patients admitted to hospital medical units with back pain

Cited by 21 publications

References 10 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

Clinical Analysis of Patients With Low Back Pain in the Emergency Department

Influence of Weekday of Admission and Level of Distress on Length of Hospital Stay in Patients With Low Back Pain: A Retrospective Cohort Study

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