Affiliations: [a] Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI, USA | [b] Haig et al. Consulting, Ann Arbor, MI, USA | [c] Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI, USA | [d] Blue Cross Blue Shield of Michigan, Detroit, MI, USA | [e] Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA
Correspondence:
[*]
Corresponding author: David J. Kohns, Department of Physical Medicine and Rehabilitation, University of Michigan,
Abstract: BACKGROUND: Low back pain is a common complaint in emergency departments (ED), where deviations from standard of care have been noted. OBJECTIVE: To relate the ordering of advanced imaging and opioid prescriptions with the presentation of low back pain in ED. METHODS: Six hundred adults with low back pain from three centers were prospectively analyzed for history, examination, diagnosis, and the ordering of tests and treatments. RESULTS: Of 559 cases the onset of pain was less than one week in 79.2%; however, most had prior low back pain, 63.5% having warning signs of a potential serious condition, and 83.9% had psychosocial risk factors. Computer tomography (CT) or magnetic resonance imaging (MRI) were ordered in 16.6%, opioids were prescribed in 52.6%, and hospital admission in 4.5%. A one-year follow-up of 158 patients found 40.8% received subsequent spine care and 5.1% had a medically serious condition. Caucasian race, age 50 years or older, warning signs, and radicular findings were associated with advanced imaging. Severe pain and psychosocial factors were associated with opioid prescribing. CONCLUSIONS: 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.
Keywords: Low back pain, emergency medicine, radiology, opioids, evidence based medicine, racial disparity, magnetic resonance imaging, computer tomography, work disability
