Workers’ compensation board claims and emergency department diagnostic management of non-specific low back pain

Background: Low back pain is a leading cause of disability worldwide and results in enormous healthcare and lost productivity costs. Guidelines exist to guide the management of low back pain, but guideline adherence varies.Objective: This study assessed whether initial presentation to the emergency department for non-specific low back pain with a Workers’ Compensation Board of Nova Scotia claim was associated with different diagnostic management from non-claimants.Methods: In this retrospective cohort study, we analyzed administrative data from four emergency departments in Nova Scotia on 18,337 adult patients who presented for non-specific low back pain between July 15, 2009 and May 1, 2019. All data were retrieved from the Nova Scotia Health Authority Emergency Department Information System.Results: Patients had a mean age of 43 years and 51.3% were female. Most patients were assigned a Canadian Triage Acuity Scale score of 3 (51.9%) and reported moderate (51.2%) to severe pain (41.5%). Occupational injuries consisted of 11.6% of visits. More than 37% of patients received one or more diagnostic test. Patients with occupational injuries were less likely to receive diagnostic tests (odds ratio [OR] = 0.52, 95% CI 0.47 to 0.58), imaging (OR = 0.60, 95% CI 0.54 to 0.67), and laboratory tests (OR = 0.35, 95% CI 0.29 to 0.43). These results remained consistent when controlling for covariates.Conclusion: Patients who presented to the emergency department for occupational non-specific low back pain were less likely to receive diagnostic tests compared to non-occupational non-specific low back pain patients.