Low-back pain management at the emergency department
About 40% population suffer from low-back pain (LBP) at some or the other point in their lives. When “red flags” are present, further tests must be employed to rule out underlying problems. However, biomedical imaging is currently overused. LBP is the most common musculoskeletal disorder seen in emergency departments (EDs) which encompasses large in-hospital and out-of-hospital economic costs.
A total 1,298 patients admitted to the ED were considered for this retrospective observational study plus all International Classification of Diseases 10 diagnosis codes for sciatica, lumbosciatica, and lumbago. The patient demographic data, medical history, lab workup and imaging executed at the ED, drugs administered at ED, ED length of stay (LOS), numeric rating scale pain score, admission to ward, and ward LOS data was gathered. Then, cost analysis was done.
As per results, mean numeric rating scale scores were higher than 7/10. In up to 90% the patients, home medication comprised of no drug consumption. The most frequently prescribed powerful opioid for home is oxycodone–naloxone. In up to 72% and 42% patients, nonsteroidal anti-inflammatory drugs and opiates were administered once at ED. Imaging was accomplished in up to 56% patients. The mean ED LOS was 4 hours, 14 minutes. Total 43 patients were admitted to a ward. In the ED, expense for each non-ward-admitted patient was approximately €200, while the mean expense for ward-admitted patients was €9,500, with a mean LOS of 15 days.
Till now, there is no defined therapeutic care process for the patient with LBP with clear criteria for an ED visit. Future studies needs to be employed to deduce a clinical pathway for the prehospital management of LBP syndrome and consequently for an in-hospital time-saving therapeutic approach to the patient.