Do Patients with Acute Low Back Pain in Emergency Departments Have More Severe Symptoms than Those in General Practice? ASystematic Review with Meta-Analysis

Crystian B Oliveira; Melanie Hamilton; Adrian Traeger; Rachelle Buchbinder; Bethan Richards; Eileen Rogan; Chris G Maher; Gustavo C Machado

doi:10.1093/pm/pnab260

Do Patients with Acute Low Back Pain in Emergency Departments Have More Severe Symptoms than Those in General Practice? ASystematic Review with Meta-Analysis

Pain Med. 2022 Apr 8;23(4):614-624. doi: 10.1093/pm/pnab260.

Authors

Crystian B Oliveira^{1

2

3}, Melanie Hamilton³, Adrian Traeger^{3

4}, Rachelle Buchbinder^{5

6}, Bethan Richards^{3

7}, Eileen Rogan⁸, Chris G Maher^{3

4}, Gustavo C Machado^{3

4}

Affiliations

¹ Physical Therapy Department, Faculty of Science and Technology, Sao Paulo State University, Presidente Prudente, Sao Paulo, Brazil.
² Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo, Brazil.
³ Institute for Musculoskeletal Health, Sydney, New South Wales, Australia.
⁴ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁵ Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.
⁶ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁷ Rheumatology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁸ Emergency Department, Canterbury Hospital, Sydney, New South Wales, Australia.

PMID: 34480571
DOI: 10.1093/pm/pnab260

Abstract

Introduction: There is a common belief that patients presenting to emergency departments have more severe pain levels and functional limitations than those who are seen in general practice. The aim of this systematic review was to compare pain and disability levels of patients with acute low back pain presenting to general practice vs those presenting to emergency departments.

Methods: Electronic searches were conducted in MEDLINE, EMBASE, and CINAHL from database inception to February 2019. Observational studies including patients with acute non-specific low back pain presenting to emergency departments and/or general practice were eligible. Pain and/or disability scores expressed on a 0-100 scale were the primary outcomes. Risk of bias was evaluated with a validated tool for observational studies, and the overall quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analysis with random effects and meta-regression were used to test for differences between the two settings.

Results: We included 12 records reporting results for 10 unique studies with a total of 6,999 participants from general practice (n = 6) and emergency departments (n = 4). There was low-quality evidence (downgraded for indirectness and inconsistency) that patients presenting to emergency departments had higher pain scores than those in general practice, with a mean difference of 17.3 points (95% confidence interval: 8.8 to 25.9 on a 0-100 scale). Similarly, there was low-quality evidence (downgraded for indirectness and inconsistency) that patients presenting to emergency departments had higher disability scores than those in general practice (mean difference: 21.7; 95% confidence interval: 4.6 to 38.7 on a 0-100 scale).

Conclusion: Patients with acute non-specific low back pain presenting to emergency departments may report higher levels of pain and disability than those seen in general practice.

Keywords: Evidence-Based Emergency Medicine; Low Back Pain; Primary Health Care.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Acute Pain* / diagnosis
Bias
Emergency Service, Hospital
General Practice*
Humans
Low Back Pain*