Management of children presenting with low back pain to emergency department.

Biagiarelli, Francesco; Piga, Simone; Reale, Antonino; Parisi, Pasquale; Atti, Marta Luisa Ciofi degli; Aulisa, Angelo Gabriele; Schingo, Paolo; Ossella, Chiara; Villa, Maria Pia; Raucci, Umberto

doi:10.1016/j.ajem.2018.07.012

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…This is in line with prior findings that most children who presented with lower back pain had nonpathologic back pain, muscle strain, or nonneurologic etiologies such as pyelonephritis. 2,3 However, in contrast to our study, prior studies found a higher rate of serious pathology at the index ED visit (2%-10%). 2,3 This is likely due to differences in methodology, because these studies did not exclude patients with serious diagnoses from prior visits.…”

Section: Discussioncontrasting

confidence: 99%

“…2,3 However, in contrast to our study, prior studies found a higher rate of serious pathology at the index ED visit (2%-10%). 2,3 This is likely due to differences in methodology, because these studies did not exclude patients with serious diagnoses from prior visits. 2,3 In addition, they included patients with a chief complaint of back pain rather than an ED diagnosis of back pain.…”

Section: Discussioncontrasting

confidence: 99%

“…6 Among the primary cohort of patients discharged from the index ED visit with a diagnosis of back pain but no serious diagnoses, we examined the patients who had a serious diagnosis made within 30 days-a frequently used time period for longitudinal follow-up in ED studies. 3,24,25,26 Based on author consensus and prior literature, 2,6,9,13 we compiled a list of serious diagnoses that can be associated with back pain, each representing a distinct ICD-10 billable code. We then consolidated the list into four mutually exclusive categories: neoplastic, infectious, anatomic, and nonneurologic (Table S1).…”

Section: Variables and Outcomesmentioning

confidence: 99%

“…While back pain is frequently musculoskeletal in origin, [1][2][3] it can be a harbinger for more serious pathology including infection and malignancy. 2,4,5,6,7,8 Serious pathologies, such as intraspinal abscess and cauda equina syndrome, require timely diagnosis and intervention to prevent severe sequelae.…”

Section: Introductionmentioning

confidence: 99%

“…21 Given such high population prevalence but low ED presentation rate of pediatric back pain, a careful evaluation, including an assessment of potential "red flag" symptoms, is needed. 2,3,13,22 No prior study has longitudinally followed pediatric patients with back pain in the ED to determine rates of serious pathology on revisits. Our objective was to characterize pediatric patients initially discharged with a principal diagnosis of back pain but no serious diagnoses detected at the index visit or known trauma and to determine their rate of serious diagnoses on revisits.…”

Section: Introductionmentioning

confidence: 99%

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Serious diagnoses at revisits in children discharged from the emergency department with back pain

Zhou

Marín

Hickey

et al. 2021

Academic Emergency Medicine

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Background: Back pain is often benign but can be a harbinger for serious pathology.Little is known about the outcome in children with back pain but no serious diagnoses detected at the initial visit. We sought to estimate the rate of serious diagnoses at revisits among children initially discharged from the emergency department (ED) with back pain. Methods:We performed a multicenter retrospective cohort study of patients from 45 pediatric hospitals in the Pediatric Health Information System database from October 1, 2015, to March 31, 2019. We included patients discharged from the ED with a principal diagnosis of back pain and excluded patients with trauma and concurrent or previously known serious diagnoses. We identified the rates and types of serious diagnoses made within 30 days of the index visit. We examined the rates of diagnostic tests at the index visit in patients with and without serious diagnoses.Results: Of the 25,130 patients with back pain, 88 (0.4%, 95% confidence interval = 0.3% to 0.4%) had serious pathology diagnosed within 30 days. The most common diagnoses were anatomic (40%) and nonneurologic (39%) categories such as vertebral fracture and nephrolithiasis; infectious (19%) and neoplastic etiologies (3%) were less common. Diagnoses requiring acute interventions such as cauda equina syndrome (n = 2) and intraspinal abscess (n = 3) were rare. Patients with serious diagnoses at revisits underwent more blood tests and back ultrasound at the index visit compared to patients without serious diagnoses. Conclusions:In pediatric patients discharged from the ED with a diagnosis of back pain and no serious or trauma diagnoses, there is a low rate of serious pathology on revisits. Of the serious diagnoses identified, high-acuity diseases were rare. For the subset of patients with clinical suspicion for serious pathology but none identified at the index visit, this represents an opportunity for further research to optimize their management.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Section: Variables and Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Serious diagnoses at revisits in children discharged from the emergency department with back pain

Zhou

Marín

Hickey

et al. 2021

Academic Emergency Medicine

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History Evaluation of the Child or Adolescent with Back Pain Including Ten Red Flags

Mundluru¹,

Otsuka

2020

Back Pain in the Young Child and Adolescent

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Six-year-old boy with a slow-onset persistent back pain

Caddeo

Paganin

Gortani

et al. 2019

Arch Dis Child Educ Pract Ed

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A 6-year-old boy was evaluated for a 6-week history of low back pain. Initially, the pain was exacerbated by movements, eventually showing a milder and fluctuating trend. History was unremarkable for previous traumatic events, fever or nocturnal pain. Physical examination revealed localised pain at palpation of the spinous processes at the lumbosacral level. Blood tests showed a normal blood count, negative C reactive protein (CRP) and erythrocyte sedimentation rate, normal lactic acid dehydrogenase (LDH) and creatine phosphokinase.A posterior–anterior radiograph of the lumbar spine resulted normal. An MRI scan revealed a lumbosacral transitional vertebra with bone oedema of the posterior arch until the spinous process.For better bone definition, a CT scan was performed (figure 1).Figure 1CT scan of the transitional lumbosacral (L5) vertebra.QuestionsWhich causes of persistent low back pain should be ruled out in children under 10 years of age?OsteochondrosisNeoplasmFunctional painInfectionsWhat is the diagnosis in this patient?How is the diagnosis performed?How is this condition managed?Answers can be found on page 2.

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Management of children presenting with low back pain to emergency department.

Cited by 5 publications

References 34 publications

Serious diagnoses at revisits in children discharged from the emergency department with back pain

Serious diagnoses at revisits in children discharged from the emergency department with back pain

History Evaluation of the Child or Adolescent with Back Pain Including Ten Red Flags

Six-year-old boy with a slow-onset persistent back pain

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