Emergency Department Observation for Back Pain: Patient Characteristics and Factors Associated with Hospital Admission or 90-day Return Visit

Background

Emergency department (ED) observation for extended work-up or intensive treatment of intractable back pain (BP) is an alternative to hospital admission. Patient characteristics and outcomes are largely unknown.

Objectives

To describe the characteristics of patients placed on ED observation for intractable BP; to determine the hospital admission rate from the ED observation unit (EDOU) and any associated factors; and to determine the 90-day recidivism rate for BP-related return visits and any associated factors.

Methods

This was a retrospective, quality improvement initiative of patients placed on ED observation from June 1, 2022, to May 31, 2023, for intractable BP. Data was abstracted from the electronic medical record by a single, trained data abstractor. Variables extracted from the medical record included age, sex, analgesic medications administered during EDOU (type and amount), pain management consultation, pain medicine procedure, EDOU discharge disposition, EDOU length of stay (LOS), 90-day return visits for any reason, and 90-day return visit for BP.

Results

Two hundred twenty-five patients were admitted to the EDOU for BP, median age 66 years, 63% female. Median EDOU LOS was 20.8 h. Hospital admission occurred in 25% and a 90-day return visit occurred in 15%. Oral opioid administration was significantly associated with hospital admission. Physical therapy consultation was significantly associated with 90-day return visit.

Conclusion

ED observation is an alternative to hospital admission for patients with intractable BP. Hospital admission from observation is consistent with national ED benchmarking for observation admission and the 90-day recidivism rate for BP is low.