title: Low-back pain at the emergency department: still not being managed?
abstract: BACKGROUND
  Low-back pain (LBP) affects about 40% of people at some point in their lives. In the presence of "red flags", further tests must be done to rule out underlying problems; however, biomedical imaging is currently overused. LBP involves large in-hospital and out-of-hospital economic costs, and it is also the most common musculoskeletal disorder seen in emergency departments (EDs).
  
  
  METHODS
  This retrospective observational study enrolled 1,298 patients admitted to the ED, including all International Classification of Diseases 10 diagnosis codes for sciatica, lumbosciatica, and lumbago. We collected patients' demographic data, medical history, lab workup and imaging performed at the ED, drugs administered at the ED, ED length of stay (LOS), numeric rating scale pain score, admission to ward, and ward LOS data. Thereafter, we performed a cost analysis.
  
  
  RESULTS
  Mean numeric rating scale scores were higher than 7/10. Home medication consisted of no drug consumption in up to 90% of patients. Oxycodone-naloxone was the strong opioid most frequently prescribed for the home. Once at the ED, nonsteroidal anti-inflammatory drugs and opiates were administered to up to 72% and 42% of patients, respectively. Imaging was performed in up to 56% of patients. Mean ED LOS was 4 hours, 14 minutes. A total of 43 patients were admitted to a ward. The expense for each non-ward-admitted patient was approximately €200 in the ED, while the mean expense for ward-admitted patients was €9,500, with a mean LOS of 15 days.
  
  
  CONCLUSIONS
  There is not yet a defined therapeutic care process for the patient with LBP with clear criteria for an ED visit. It is to this end that we need a clinical pathway for the prehospital management of LBP syndrome and consequently for an in-hospital time-saving therapeutic approach to the patient.
authors.affiliation: Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rizzardo
authors.affiliation: Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Miceli
authors.affiliation: Pain Medicine and Palliative Care, Health Company Number 2, Gorizia, Italy.
authors.forename: Rym
authors.initials: R
authors.lastname: Bednarova
authors.affiliation: Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, Italy.
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Guadagnin
authors.affiliation: Emergency Department, Academic Hospital of Udine, Udine, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sbrojavacca
authors.affiliation: Department of Anesthesia and Intensive Care, Academic Hospital of Udine, University of Udine, Udine, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Della Rocca
keywords: cost analysis; emergency department; health policies; low-back pain