Profile and management of patients with low back pain complaints in a Brazilian Emergency Department: a cross-sectional retrospective study
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Abstract
Objective: To describe the demographic profile and the management of patients with low back pain (LBP) complaints presenting to the Emergency Department (ED) of a Brazilian public hospital. Methods: Retrospective, cross-sectional study using a convenience sample of patients with LBP triaged at the studied ED through the Manchester Triage System along a year. Data were extracted from electronic medical records. LBP presentations were classified as non-traumatic, traumatic, and non-spinal related pain according to the signs and symptoms reported. Data included patients’ demographic profile, pain severity and management (e.g., imaging exams, medication prescription and hospitalization). Results: Data from 2016 patients was analyzed. Most were middle-aged adults (mean age = 40.5years, SD 15.7), female (n = 1043, 51.7%) and presented moderate pain intensity (score range 4 to 7 on the Visual Analogue Scale, n=1,471; 74.1%). Non-traumatic pain (n = 1,016; 50.4%) was the main cause of care-seeking. A total of 36.9% (n = 743) underwent imaging exams and 42.2% (n = 850) received medication. Patients with non-spinal related pain were three times more likely to receive opioid medication (OR = 2.96; 95%CI 2.30 to 3.79). Conclusion: Non-traumatic LBP (i.e., no history of trauma or red flags) was the main cause of LBP care-seeking in a Brazilian ED. Most patients were treated conservatively and without hospitalization. Opioids prescription and imaging exams, although performed on a smaller scale, were still used for of the management of this type of LBP.
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References
Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-67. Doi: 10.1016/S0140-6736(18)30480-X
Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine. 2008;33(1):95-103. doi: 10.1097/BRS.0b013e31815e7f94
Garcia JBS, Hernandez-Castro JJ, Nunez RG, Pazos MAR, Aguirre JO, Jreige A, et al. Prevalence of low back pain in Latin America: a systematic literature review. Pain physician [Internet]. 2014[cited 2020 Ago 01];17:379-91. Available from: www.painphysicianjournal.com/current/pdf?article=MjE1NQ==&journal=84
Taylor JB, Goode AP, George SZ, Cook CE. Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis. Spine J. 2014;14(10):2299-319. doi: 10.1016/j.spinee.2014.01.026
Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769-81. doi: 10.1016/j.berh.2010.10.002
Lemeunier N, Leboeuf-Yde C, Gagey O. The natural course of low back pain: a systematic critical literature review. Chiropr Man Therap. 2012;20(1):33. doi: 10.1186/2045-709X-20-33
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211-59. doi: 10.1016/S0140-6736(17)32154-2
Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-37. Doi: 10.1002/art.34347
Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075-94. doi: 10.1007/s00586-010-1502-y
Nunn ML, Hayden JA, Magee K. Current management practices for patients presenting with low back pain to a large emergency department in Canada. BMC Musculoskelet Disord. 2017;18(1):92. doi: 10.1186/s12891-017-1452-1
Waterman BR, Belmont PJ, Schoenfeld AJ. Low back pain in the United States: incidence and risk factors for presentation in the emergency setting. Spine J. 2012;12(1):63-70. doi: 10.1016/j.spinee.2011.09.002
Edwards J. The prevalence of low back pain in the emergency department: A systematic review and primary study in the Charles V. Keating Emergency and Trauma Centre [Master Dissertation]. Halifax: Dalhousie University; 2016 [cited 2020 Ago 02]. Available from: dalspace.library.dal.ca/bitstream/handle/10222/72160/Edwards-Jordan-MSc-CHE-August-2016.pdf?sequence=1
Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK. National trends in use of computed tomography in the emergency department. Ann Emerg Med. 2011;58(5):452-62.e3. doi: 10.1016/j.annemergmed.2011.05.020
Canadian Institute for Health Information. A snapshot of health care in Canada as demonstrated by top 10 Lists. Ottawa, Ont: CIHI; 2012 [cited 2020 Ago 02]. Available from: secure.cihi.ca/free_products/Top10ReportEN-Web.pdf
Ferreira G, Costa LM, Stein A, Hartvigsen J, Buchbinder R, Maher CG. Tackling low back pain in Brazil: a wake-up call. Braz J Phys Ther. 2019;23(3):189-95. doi: 10.1016/j.bjpt.2018.10.001
Galliker G, Scherer DE, Trippolini MA, Rasmussen-Barr E, LoMartire R, Wertli MM. Low back pain in the emergency department: prevalence of serious spinal pathologies and diagnostic accuracy of red flags. Am J Med. 2020;133(1):60-72.e14. doi: 10.1016/j.amjmed.2019.06.005
Parenti N, Reggiani MLB, Iannone P, Percudani D, Dowding D. A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System. Int J Nurs Stud. 2014;51(7):1062-9. doi: 10.1016/j.ijnurstu.2014.01.013
Azeredo TRM, Guedes HM, de Almeida RAR, Chianca TCM, Martins JCA. Efficacy of the Manchester Triage System: a systematic review. Int Emerg Nurs. 2015;23(2):47-52. Doi: 10.1016/j.ienj.2014.06.001
Anziliero F, Soler D, Elis B, Silva BAd, Tanccini T, Beghetto MG. Manchester System: time spent on risk classification and priority of care at an emergency medical service. Revista gaucha de enfermagem. 2016;37(4):e64753. doi: 10.1590/1983-1447.2016.04.64753
da Costa JSM. Serviços de urgência e emergência hospitalar: atendimento não urgente nas redes de atenção às urgências, num contexto de transformações demográficas [PhD Thesis]. Belo Horizonte: Universidade Federal de Minas Gerais; 2011 [cited 2020 Ago 02]. Available from: repositorio.ufmg.br/handle/1843/AMSA-8UYQ59
McCormack HM, David JdL, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18(4):1007-19. doi: 10.1017/S0033291700009934
World Health Organization (WHO) [Internet]. WHO’s cancer pain ladder for adults. Geneva: WHO; 2016 [cited 2020 Ago 02]. Available from: www.who.int/cancer/palliative/painladder/en
Junqueira D, Ferreira M, Refshauge K, Maher C, Hopper J, Hancock M, et al. Heritability and lifestyle factors in chronic low back pain: results of the Australian Twin Low Back Pain Study (The AUTBACK study). Eur J Pain. 2014;18(10):1410-8. doi: 10.1002/ejp.506
Edwards J, Hayden J, Asbridge M, Gregoire B, Magee K. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017;18(1):143. doi: 10.1186/s12891-017-1511-7
Buchbinder R, van Tulder M, Öberg B, Costa LM, Woolf A, Schoene M, et al. Low back pain: a call for action. Lancet. 2018;391(10137):2384-8. doi: 10.1016/S0140-6736(18)30488-4
Edwards J, Hayden J, Asbridge M, Magee K. The prevalence of low back pain in the emergency department: a descriptive study set in the Charles V. Keating Emergency and Trauma Centre, Halifax, Nova Scotia, Canada. BMC Musculoskelet Disord. 2018;19(1):306. doi: 10.1186/s12891-018-2237-x
Friedman BW, Chilstrom M, Bijur PE, Gallagher EJ. Diagnostic testing and treatment of low back pain in US emergency departments. A national perspective. Spine (Phila Pa 1976). 2010;35(24):E1406-11. Doi: 10.1097/brs.0b013e3181d952a5
Machado GC, Rogan E, Maher CG. Managing non‐serious low back pain in the emergency department: Time for a change? Emerg Med Australas. 2017;30(2):279-82. Doi: 10.1111/1742-6723.12903
Chou R, Qaseem A, Snow V, Casey D, Cross JT, Jr., Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-91. Doi: 10.7326/0003-4819-147-7-200710020-00006
Cantrill SV, Brown MD, Carlisle RJ, Delaney KA, Hays DP, Nelson LS, et al. Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department. Ann Emerg Med. 2012;60(4):499-525. doi: https://doi.org/10.1016/j.annemergmed.2012.06.013
Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, et al. ACR Appropriateness Criteria Low Back Pain. J Am Coll Radiol. 2016;13(9):1069-78. doi: 10.1016/j.jacr.2016.06.008
Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(101370):2368-83. doi: 10.1016/S0140-6736(18)30489-6n