Emergency department evaluation, treatment, and functional outcomes among patients presenting with low back pain

Objectives: Low back pain (LBP) leads to more than 4.3 million emergency department (ED) visits annually. De-spite the number of ED visits for LBP, emergency medicine societies have not established clear guidelines for the evaluation and care of these patients. This study aims to describe patterns in the evaluation, treatment, and out-comes of patients presenting to an urban, academic ED for atraumatic LBP.Methods: We prospectively identified a convenience sample of patients presenting with LBP to the University of Utah Hospital ED between January 2017 and June 2018. We collected baseline demographic information and cal-culated the Patient-Reported Outcomes Measurement Information System Physical Function Short Form 12a (PROMIS PFSF-12a) score to assess patient function and mobility (50 = average PROMIS PFSF-12a score, with higher scores indicating better function). We contacted patients 6 weeks after the ED visit to assess outpatient follow-up and functional outcomes.Results: Over the 18-month study period, 103 patients presented with a chief complaint of LBP and agreed to par-ticipate in the study. Average age of the cohort was 48.5 years (SD = 18.3) and 55 (53.4%) were female. Notably, 61 patients (59.2%) had been seen previously in the ED for LBP and 32 (31.1%) had received an opioid for LBP in the preceding 3 months. In the ED, 35.9% of patient received an opioid while 18.5% had an opioid prescription at discharge. While in the ED, 37 (35.9%) had an x-ray and 47 (45.6%) underwent computed tomography or mag-netic resonance imaging. At 6-week follow-up, 22 of 68 (32.4%) patients reported having missed work due to pain. PROMIS PFSF-12a score improved from 32.2 (low range) at time of ED visit to 42.0 (low-average range) at the 6-week follow up. Regarding outpatient follow-up after the ED visit, 22 patients (21.4%) saw a pri-mary care provider, 12 patients (17.8%) saw orthopedics or neurosurgery, and 8 patients (11.8%) attended phys-ical therapy Conclusions: Patients receiving ED care for LBP had a significant improvement in PROMIS PFSF-12a scores 6 weeks after the ED but return to function continued to lag despite interventions. Imaging patterns, medication prescrip-tions, and outpatient follow-up varied widely, emphasizing the needs for clear guidelines and treatment path-ways for ED patients with LBP.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study aims to describe patterns in the evaluation, treatment, and outcomes of patients presenting to an urban, academic emergency department (ED) for atraumatic low back pain (LBP). The results show that patients receiving ED care for LBP had a significant improvement in physical function and mobility scores at 6 weeks, but their return to function continued to lag behind. There were variations in imaging patterns, medication prescriptions, and outpatient follow-up, highlighting the need for clear guidelines and treatment pathways for ED patients with LBP.