Emergency presentations for older persons with low back pain: An increasing clinical and economic challenge

Rod Ellem, Rowan Pickering*, Darryn Marks, James Todd, Jarryd Brown, Shelley Roberts, Zoe A. Michaleff

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

Objective
To determine whether differences exist for older persons presenting to Emergency Departments (EDs) with lower back pain (LBP) in terms of management, health service resource use and cost when compared to younger patients with LBP.

Methods
Retrospective analysis of routinely collected electronic medical record data from January 2015 to July 2021. Data from 11,098 adults presenting with LBP to two large regional Australian EDs were analysed over a 5-year period. Rates of presentation, investigation, medication use, spinal surgery and cost were assessed for all participants with respect to age groups (over or under 65 years of age), diagnosis and time. Multivariable logistic regression analysis was employed to assess the contribution of presentation characteristics to the risk of inpatient admission and to investigate the variable effect of patient age.

Results
Older people represented 23% (n = 2565) of all LBP presentations, with a growing proportion of presentations over time. More than 1 in 4 patients over 65 were admitted (n = 703, 27%), with CT imaging being proportionately three times more prevalent (24% vs. 6%), and average cost double (AU$3973 vs. $1671) that of the younger population. Consultation by an ED physiotherapist was associated with lower admission risk across all adult presentations (OR 0.52, 95% CI [0.40 to 0.67]).

Conclusions
Older persons are over-represented amongst gradually increasing rates of LBP presentations to EDs and associated with escalating cost of care and hospital resource use. Older patients present a different clinical and economic profile to younger patients, supporting the provision of individualised management recommendations.
Original languageEnglish
Pages (from-to)742-750
Number of pages9
JournalAustralasian Journal on Ageing
Volume42
Issue number4
Early online date5 Oct 2023
DOIs
Publication statusPublished - Dec 2023

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