Journal Article

Management of low back pain in Australian emergency departments

Machado, Gustavo C, Needs, Chris, Rogan, Eileen, Lin, Chung-Wei Christine, Facer, Rochelle, Richards, Bethan, Ferreira, Giovanni E, Edwards, James, Maher, Christopher G, Abdel Shaheed, Christina

2019

Overview

BackgroundTo describe the diagnoses of people who present to the emergency department (ED) with low back pain (LBP), the proportion of people with a lumbar spine condition who arrived by ambulance, received imaging, opioids and were admitted to hospital; and to explore factors associated with these four outcomes.MethodsIn this retrospective study, we analysed electronic medical records for all adults presenting with LBP at three Australian EDs from January 2016 to June 2018. Outcomes included discharge diagnoses and key aspects of care (ambulance transport, lumbar spine imaging, provision of opioids, admission). We explored factors associated with these care outcomes using multilevel mixed-effects logistic regression models and reported data as ORs.ResultsThere were 14 024 presentations with a ‘visit reason’ for low back pain, of which 6393 (45.6%) had a diagnosis of a lumbar spine condition. Of these, 31.4% arrived by ambulance, 23.6% received lumbar imaging, 69.6% received opioids and 17.6% were admitted to hospital. Older patients (OR 1.79, 95% CI 1.56 to 2.04) were more likely to be imaged. Opioids were less used during working hours (OR 0.81, 95% CI 0.67 to 0.98) and in patients with non-serious LBP compared with patients with serious spinal pathology (OR 1.65, 95% CI 1.07 to 2.55). Hospital admission was more likely to occur during working hours (OR 1.74, 95% CI 1.48 to 2.05) and for those who arrived by ambulance (OR 2.98, 95% CI 2.53 to 3.51).ConclusionMany ED presentations of LBP were not due to a lumbar spine condition. Of those that were, we noted relatively high rates of lumbar imaging, opioid use and hospital admission.

• Publisher: BMJ Publishing Group LTD
• Subject: Adult / Aged / Ambulances - statistics & numerical data / Analgesics / Analgesics, Opioid - therapeutic use / Back pain / Clinical trials / Drug dosages / Electronic health records / Emergency medical care / Emergency medical services / Emergency Service, Hospital / Female / Hospitalization - statistics & numerical data / Hospitals / Humans / Low Back Pain - diagnosis / Low Back Pain - drug therapy / Low Back Pain - epidemiology / Lumbosacral Region / Male / Medical records / Middle Aged / Narcotics / New South Wales - epidemiology / Pathology / Patients / Retrospective Studies / Risk Factors / Socioeconomic factors / Spine / Systematic review