Low Back Pain Presentation and Management at the Emergency Department: Differences Between Older Adults Residing in the Community and Aged Care Homes

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice Pub Date : 2025-04-11 DOI:10.1111/jep.70088

Rod Ellem, Quinn Burling, Michel W. Coppieters, James Todd, Rowan Pickering

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引用次数: 0

Abstract

Rationale

In healthcare systems without gatekeeper access to Emergency Departments (ED), the number of people presenting for low back pain (LBP) is increasing substantially. Low back pain presentations at the Emergency Department are rarely caused by serious underlying pathology, and management often deviates from practice guidelines. Older adults (≥ 65 years) constitute approximately 30% of all ED LBP presentations. Little is known about differences in presentation characteristics and ED management between older adults from aged care homes and those living in the community.

Aims and Objectives

This study aimed to identify differences in presentation and management between people presenting at the ED for LBP from aged care homes versus those residing in the community.

Methods

Retrospective observational study of routinely collected healthcare data and chart audits of older adults from aged care homes (N = 64) and age and sex-matched community-dwelling older adults (N = 64) presenting to ED for LBP.

Results

Patients from aged care homes presented with more comorbidities (4 vs. 2), analgesic medication (84% vs. 70%) and polypharmacy (86% vs. 41%) and were more commonly admitted for ongoing analgesia or further diagnostic tests. Community-dwelling older adults were more frequently admitted for Allied Health input. ED administration of opiates was high for both groups (81% aged care; 91% community-dwelling). High rates of lumbar spine medical imaging (61% aged care; 50% community-dwelling) resulted in few acute radiographic findings.

Conclusions

Older patients presenting to ED for LBP receive similar management regardless of their residential status. Hospital management of both groups does not align with current published recommendations namely in respect to imaging and pain medication.

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急诊科的腰痛表现和处理：居住在社区和养老院的老年人之间的差异

在没有门房进入急诊科（ED）的医疗保健系统中，因腰痛（LBP）就诊的人数正在大幅增加。急诊科的腰痛表现很少是由严重的潜在病理引起的，治疗往往偏离实践指南。老年人（≥65岁）约占所有ED下腰痛病例的30%。对于来自老年护理之家的老年人和生活在社区的老年人在表现特征和ED管理方面的差异知之甚少。目的和目的本研究旨在确定老年护理之家与社区居民在急诊科就诊的腰痛患者在表现和管理方面的差异。方法回顾性观察研究来自养老院（N = 64）和年龄和性别匹配的社区居住老年人（N = 64）的常规收集的医疗保健数据和图表审计。结果老年护理院的患者表现出更多的合并症（4对2），镇痛药物（84%对70%）和多种药物（86%对41%），并且更常见的是接受持续的镇痛或进一步的诊断测试。社区居住的老年人接受联合健康服务的频率更高。两组在ED中使用阿片类药物的比例都很高(81%老年人护理；91%的社区)。腰椎医学显像率高(老年护理61%；50%居住在社区)导致很少的急性x线表现。结论：无论居住状况如何，因腰痛而出现ED的老年患者均可接受类似的治疗。两组的医院管理不符合目前公布的建议，即在影像学和止痛药方面。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.