Trends in the Evaluation and Management of Back Pain in Emergency Departments, United States, 2007–2016

Author:

Mullins Peter M12,Merriman John Gates3,Jaffe Todd A12,Mazer-Amirshahi Maryann4,Weiner Scott G1

Affiliation:

1. Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts, USA

2. Department of Emergency Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA

3. Department of Anesthesiology, University of Illinois Chicago, Chicago, Illinois, USA

4. Department of Emergency Medicine, MedStar Washington Hospital Center; Georgetown University School of Medicine, Washington, DC, USA

Abstract

Abstract Objective  Back pain is one of the most common pain syndromes in the United States, but there has been limited recent description of the role of emergency departments (EDs) in caring for patients with back pain. We investigated trends in the evaluation and management of back pain in U.S. EDs from 2007 to 2016. Methods  We performed a retrospective analysis of the National Hospital Ambulatory Medical Care Survey, a nationally representative annual survey of ED visits, which includes data on patient-, hospital-, and visit-level characteristics. We evaluated trends among adult ED visits for back pain, including demographics, resource utilization, and disposition. Trends were assessed through the use of survey-weighted analyses. Results  Visit rates as a proportion of overall ED visits were stable from 2007 to 2016 (9.1% [95% confidence interval (CI): 8.5–9.6] vs. 9.3% [95% CI: 8.6–10.0]; P = 0.44). Admission rates declined from 6.4% (95% CI: 5.1–8.0) to 5.0% (95% CI: 3.5–6.9; P < 0.001). Imaging utilization increased from 51.7% (95% CI: 49.3–54.1) to 57.6% (95% CI: 53.3–61.7; P = 0.023), with an increase of 58.3% in computed tomography. Overall opioid utilization declined from 53.5% (95% CI: 49.4–57.5) to 46.5% (95% CI: 43.2–49.8; P < 0.001). Tramadol use increased over the study period (4.1% [95% CI: 3.0–5.8] vs. 8.4% [95% CI: 6.6–10.7]; P < 0.001). Conclusions  Opioid utilization during ED visits for back pain decreased from 2007 to 2016, whereas tramadol use more than doubled. Care intensity increased significantly despite declining admission rates. Further research into optimal strategies for back pain management in the ED is needed.

Publisher

Oxford University Press (OUP)

Subject

Anesthesiology and Pain Medicine,Neurology (clinical),General Medicine

Reference40 articles.

1. Epidemiology and risk factors for spine pain;Rubin;Neurol Clin,2007

2. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017 [published correction appears in Lancet. 2019 Jun 22; 393(10190):e44];Lancet,2018

3. US health care spending by payer and health condition, 1996–2016;Dieleman;JAMA,2020

4. Back injuries prominent in work-related musculoskeletal disorder cases in 2016,2018

5. Back pain prevalence and visit rates: Estimates from U.S. national surveys, 2002;Deyo;Spine,2006

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3