Clinical predictors of the medical interventions provided to patients with low back pain in the emergency department

Kohns, David J.; Haig, Andrew J.; Uren, Brad; Thompson, Jeffery N.; Muraglia, Katrina A; Loar, Sierra; Share, David; Shedden, Kerby; Spires, Mary Catherine

doi:10.3233/bmr-170806

Cited by 24 publications

(29 citation statements)

References 14 publications

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“…The prevalence of a cauda equina syndrome or radiculopathy with weakness was 1.9% in one prospective observational study. 5 In retrospective studies, a cauda equina syndrome was found in 0.3-0.5%, 26,27 and in patients with neurological deficits in 1.7%. 24 One retrospective study reported a higher prevalence of spinal cord/cauda equina compression (15.5%) in patients referred to an orthopedic team because of neurological symptoms.…”

Section: Prevalence Of Specific Spinal Pathologiesmentioning

confidence: 95%

“…4 The prevalence in the ED setting is unclear and it is reasonable to assume it to be higher compared to the primary care setting. 5 Red flags are signs/symptoms that help to identify patients at risk for a serious underlying disease. 6 However, there is no consensus on which red flags should be screened for: 16 guidelines recommended 46 different red flags.…”

Section: Introductionmentioning

confidence: 99%

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Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags

Galliker

Scherer

Trippolini

et al. 2020

The American Journal of Medicine

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Background: Very little evidence is available on the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting to the emergency department (ED). This systematic review aims to investigate the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting with low back pain to the ED. Methods: We systematically searched MEDLINE, PUBMED, EMBASE, Cochrane Library, and SCOPUS from inception to January 2019. Two reviewers independently reviewed the references and evaluated methodological quality. Results: We analyzed 22 studies with a total of 41'320 patients. The prevalence of any serious spinal pathology requiring immediate/urgent treatment was 2.5-5.1% in prospective and 0.7-7.4% in retrospective studies (0.0-7.2% for vertebral fractures, 0.0-2.1% for spinal cancer, 0.0-1.9% for infectious disorders, 0.1-1.9% for pathologies with spinal cord/cauda equina compression, 0.0-0.9% for vascular pathologies). Examples of red flags which increased the likelihood for a serious condition were: suspicion and/or history of cancer (spinal cancer); intravenous drug use, indwelling vascular catheter, other infection site (epidural abscess). Conclusion: We found a higher prevalence of serious spinal pathologies in the ED compared to the reported prevalence in primary care settings. As the diagnostic accuracy of most red flags was reported only by a single study, further validation in high quality prospective studies is needed.

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Section: Prevalence Of Specific Spinal Pathologiesmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags

Galliker

Scherer

Trippolini

et al. 2020

The American Journal of Medicine

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“…Previous research demonstrated a relationship between dynamic physical tests, self-reported LBP and reduced function. 38 However, such research has been neglected in recent decades 29–32 as focus shifted towards physiological and radiological findings 9 10 and biopsychosocial attributes. 3 6 7 11 Grönblad et al 38 showed three physical exercises (repetitive sit-ups, squats and EIL) had a positive correlation with LBP.…”

Section: Discussionmentioning

confidence: 99%

“…These include: medical investigative relationships such as radiological 23 24 or physiological findings 25–27 that have produced mixed results even from the same study 28 and biopsychosocial considerations 29–32 or a mixture of these. 9–11 In contrast, modifiable factors 33 34 including movement patterns, 14 35 physiological loads 36 and exercise capacity 37 38 receive limited attention yet they significantly influence LBP morbidity and symptomology, 1 2 being recognised as potentially able to prevent LBP. 11 20 …”

Section: Introductionmentioning

confidence: 99%

Does the performance of five back-associated exercises relate to the presence of low back pain? A cross-sectional observational investigation in regional Australian council workers

Gabel¹,

Mokhtarinia

Hoffman³

et al. 2018

BMJ Open

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ObjectivesInvestigate the relationships between the ability/inability to perform five physical test exercises and the presence or absence of low back pain (LBP).SettingRegional Australian council training facility.ParticipantsConsecutive participants recruited during 39 back education classes (8–26 participants per class) for workers in general office/administration, parks/gardens maintenance, roads maintenance, library, child care and management. Total sample (n=539) was reduced through non-consent and insufficient demographic data to n=422. Age 38.6±15.3 years, range 18–64 years, 67.1% male.MethodsCross-sectional, exploratory, observational investigation. LBP presence was ascertained from a three-response option questionnaire: 0=none/rarely (no) 1=sometimes (some), 2=mostly/always (most). Statistical correlation was performed with the number of the five test exercises the individual successfully performed: (1) extension in lying: 3 s; (2) ‘toilet squat’; feet flat, feet touched: 3 s; (3) full squat then stand up: 5 times; (4) supine sit-up, knees flexed: 10 times; and (5) leg extension, supine bilateral: 10 times.InterventionsNil.ResultsFor the group ‘no-some’, 94.3% completed 4–5 test exercises, while for group ‘With’, 95.7% completed 0–1 test exercises. The relationship between LBP presence and number of exercises performed was highly significant (χ2 (10)=300.61, p<0.001). Furthermore, multinomial logistic regression predicting LBP (0=no, 1=some, 2=most) from the number of exercises completed, substantially improved the model fit (initial-2LL=348.246, final-2LL=73.620, χ2 (2)=274.626, p<0.001). As the number of exercises performed increased, the odds of reporting ‘some LBP’ or ‘most LBP’ dropped substantially (ORs of 0.34 and 0.17, respectively).ConclusionThe ability to complete/not complete five test exercises correlated statistically and significantly with a higher LBP absence/presence in a general working population. Training individuals to complete such exercises could facilitate reductions in LBP incidence; however, causality cannot be inferred. Randomised trials are recommended to establish the potential efficacy of exercise-based approaches, considering these five selected exercises, for predicting and managing LBP.

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“…Low‐back pain (LBP) is a frequent presentation to the emergency department (ED) . While some ED studies indicate that serious medical conditions among patients presenting to the ED with LBP are sufficiently common (5%), other studies have reported that over 60% of LBP presentations to the ED are “benign” or “nonspecific” as they lack the concerning (so‐called “red flags”) symptoms used to identify high‐risk patients described in various guidelines . Clinical practice guidelines (CPG) and several international campaigns recommend that lumbar spine imaging be avoided in the ED for adults with nontraumatic LBP in the absence of these red flags.…”

mentioning

confidence: 99%

Effectiveness of Interventions to Decrease Image Ordering for Low Back Pain Presentations in the Emergency Department: A Systematic Review

Liu

Desai

Krebs

et al. 2018

Academic Emergency Medicine

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While imaging of LBP has been identified as a key area of imaging overuse (e.g., Choosing Wisely recommendation), evidence on interventions to reduce image ordering for ED patients with LBP is sparse. There is some evidence to suggest that interventions can reduce the use of simple imaging in LBP in the ED; however, a shift in imaging modality has also been demonstrated. Additional studies employing higher-quality methods and measuring intervention fidelity are strongly recommended to further explore the potential of ED-based interventions to reduce image ordering for this patient population.

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Clinical predictors of the medical interventions provided to patients with low back pain in the emergency department

Abstract: Most patients present to the ED with acute exacerbations of chronic low back pain. Risk factors for a serious condition are common, but rarely do they develop. Racial disparities and psychosocial factors had concerning relationships with clinical decision-making.

Cited by 24 publications

References 14 publications

Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags

Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags

Does the performance of five back-associated exercises relate to the presence of low back pain? A cross-sectional observational investigation in regional Australian council workers

Effectiveness of Interventions to Decrease Image Ordering for Low Back Pain Presentations in the Emergency Department: A Systematic Review

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