TY - JOUR
T1 - Management of patients presenting with low back pain to a private hospital emergency department in Melbourne, Australia
AU - Buchbinder, Rachelle
AU - Bourne, Allison
AU - Staples, Margaret
AU - Lui, Chris
AU - Walker, Katie
AU - Ben-Meir, Michael
AU - Gorelik, Alexandra
AU - Blecher, Gabriel
N1 - Funding Information:
RB is supported by an NHMRC Investigator Fellowship.
Publisher Copyright:
© 2021 Australasian College for Emergency Medicine
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2022/4
Y1 - 2022/4
N2 - 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, 95% CI 1.12–3.11). 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.
AB - 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, 95% CI 1.12–3.11). 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.
KW - emergency department
KW - imaging
KW - low back pain
KW - opioid
KW - quality of care
UR - http://www.scopus.com/inward/record.url?scp=85108320105&partnerID=8YFLogxK
U2 - 10.1111/1742-6723.13814
DO - 10.1111/1742-6723.13814
M3 - Article
C2 - 34164911
AN - SCOPUS:85108320105
VL - 34
SP - 157
EP - 163
JO - EMA - Emergency Medicine Australasia
JF - EMA - Emergency Medicine Australasia
SN - 1742-6731
IS - 2
ER -