Low Back Pain

Abstract

Study design /setting. Retrospective study. Objective. To understand what patients utilize emergency departments (EDs) versus urgent care centers for low back pain (LBP). Summary of Background Data. LBP is a common reason for ED visits. In the setting of trauma, or recent surgery, the resources of EDs may be needed. However, urgent care centers, may be appropriate for other cases. Methods. Adult patients less than 65 years of age presenting to the ED or urgent care on the day of diagnosis of low back pain were identified from the 2019 PearlDiver M151 administrative database. Exclusion criteria included history of radiculopathy or sciatica, spinal surgery, spinal cord injury, other traumatic, neoplastic, or infectious diagnoses in the 90 days prior, or Medicare insurance. Patient age, sex, Elixhauser Comorbidity Index (ECI), geographic region, insurance, and management strategies were extracted. Factors associated with urgent care relative to ED utilization were assessed using multivariable analysis. Results. Of 356,284 LBP patients, ED visits were identified for 345,390 (96.9%) and urgent care visits for 10,894 (3.1%). Factors associated with urgent care use relative to the ED were: geographic region (relative to Midwest; Northeast odds ratio (OR) 5.49, South OR 1.54, West OR 1.32), insurance (relative to Medicaid; Commercial OR 4.06), lower ECI (OR 1.28 per 2-point decrease), and higher age (OR 1.10 per decade), female sex (OR 1.09), and use of advanced imaging (OR 0.08) within 1 week (P<0.001 for all). Conclusions. Most patients presenting for a first diagnosis of isolated LBP went to the ED relative to urgent care. The greatest drivers of urgent care versus ED utilization for low back pain were insurance type and geographic region. Utilization of advanced imaging was higher among ED patients, but rates of surgical intervention were similar between those seen in the ED and urgent care.