{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T12:19:41Z","timestamp":1784809181201,"version":"3.55.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008132","name":"HCF Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008132","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001774","name":"University of Sydney","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001774","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Rheumatol"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>To determine the proportion of patients admitted to the hospital for back pain who have nonserious back pain, serious spinal, or serious other pathology as their final diagnosis. The proportion of nonserious back pain admissions will be used to plan for future \u2018virtual hospital\u2019 admissions. Electronic medical record data between January 2016 and September 2020 from three emergency departments (ED) in Sydney, Australia were used to identify inpatient admissions. SNOMED-CT-AU diagnostic codes were used to select ED patients aged 18 and older with an admitting diagnosis related to nonserious back pain. The inpatient discharge diagnosis was determined from the primary ICD-10-AM codes by two independent clinician-researchers. Inpatient admissions were then analysed by sociodemographic and hospital admission variables. A total of 38.1% of patients admitted with a provisional diagnosis of nonserious back pain were subsequently diagnosed with a specific pathology likely unsuitable for virtual care; 14.2% with a serious spinal pathology (e.g., fracture and infection) and 23.9% a serious pathology beyond the lumbar spine (e.g., pathological fracture and neoplasm). A total of 57% of admissions were identified as nonserious back pain, likely suitable for virtual care. A challenge for implementing virtual care in this setting is screening for patients with serious pathology. Protocols need to be developed to reduce the risk of patients being admitted to virtual hospitals with serious pathology as the cause of their back pain.\n<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>Key Points<\/jats:bold><jats:italic>\u2022 Among admitted patients provisionally diagnosed in ED with non-serious back pain,\n38.1% were found to have \u2018serious spinal pathologies\u2019 or \u2018serious pathologies beyond the lumbar spine\u2019 at discharge.<\/jats:italic><jats:italic>\u2022 Spinal fractures were the most common serious spinal pathology, accounting for 9%\nof all provisional \u2018non-serious back pain\u2019 admissions from ED.<\/jats:italic><jats:italic>\u2022 57% of back pain admissions were confirmed to be non-serious back pain and may be\nsuitable to virtual hospital care; the challenge is discriminating these patients from\nthose with serious pathology.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s10067-022-06054-w","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T11:02:44Z","timestamp":1641898964000},"page":"1867-1871","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Many people admitted to hospital with a provisional diagnosis of nonserious back pain are subsequently found to have serious pathology as the underlying cause"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3726-1477","authenticated-orcid":false,"given":"Alla","family":"Melman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris G.","family":"Maher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Needs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo C.","family":"Machado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"issue":"11","key":"6054_CR1","doi-asserted-by":"publisher","first-page":"2791","DOI":"10.1007\/s00586-018-5673-2","volume":"27","author":"CB Oliveira","year":"2018","unstructured":"Oliveira CB et al (2018) Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 27(11):2791\u20132803","journal-title":"Eur Spine J"},{"issue":"1","key":"6054_CR2","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1186\/s12891-017-1511-7","volume":"18","author":"J Edwards","year":"2017","unstructured":"Edwards J et al (2017) Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord 18(1):143","journal-title":"BMC Musculoskelet Disord"},{"key":"6054_CR3","unstructured":"Australian Institute of Health and Welfare (2020)\u00a0Emergency department care. https:\/\/www.aihw.gov.au\/reports-data\/myhospitals\/sectors\/emergency-department-care. Accessed 11 Jan 2022"},{"issue":"10","key":"6054_CR4","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1136\/bmjqs-2019-009383","volume":"28","author":"GE Ferreira","year":"2019","unstructured":"Ferreira GE et al (2019) Management of low back pain in Australian emergency departments. BMJ Qual Saf 28(10):826","journal-title":"BMJ Qual Saf"},{"key":"6054_CR5","doi-asserted-by":"crossref","unstructured":"Buchbinder R et al (2021) Management of patients presenting with low back pain to a private hospital emergency department in Melbourne, Australia. Emergency Medicine Australasia. Epub ahead of print","DOI":"10.1111\/1742-6723.13814"},{"key":"6054_CR6","doi-asserted-by":"crossref","unstructured":"Coombs DM et al (2021) Healthcare costs due to low back pain in the emergency department and inpatient setting in Sydney, Australia. The Lancet Regional Health \u2013 Western Pacific\u00a07","DOI":"10.1016\/j.lanwpc.2020.100089"},{"issue":"3","key":"6054_CR7","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.jphys.2021.06.018","volume":"67","author":"A Melman","year":"2021","unstructured":"Melman A, Maher CG, Machado GC (2021) Virtual hospitals: why we need them, how they work and what might come next. J Physiother 67(3):156\u2013157","journal-title":"J Physiother"},{"key":"6054_CR8","doi-asserted-by":"crossref","unstructured":"Sitammagari K et al (2020) Insights from rapid deployment of a \"virtual hospital\" as standard care during the covid-19 pandemic. Ann Intern Med","DOI":"10.7326\/M20-4076"},{"issue":"2","key":"6054_CR9","doi-asserted-by":"publisher","first-page":"77","DOI":"10.7326\/M19-0600","volume":"172","author":"DM Levine","year":"2020","unstructured":"Levine DM et al (2020) Hospital-level care at home for acutely ill adults: a randomized controlled trial. Ann Intern Med 172(2):77\u201385","journal-title":"Ann Intern Med"},{"issue":"1","key":"6054_CR10","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.amjmed.2019.06.005","volume":"133","author":"G Galliker","year":"2020","unstructured":"Galliker G et al (2020) Low back pain in the emergency department: prevalence of serious spinal pathologies and diagnostic accuracy of red flags. Am J Med 133(1):60-72.e14","journal-title":"Am J Med"},{"key":"6054_CR11","doi-asserted-by":"crossref","unstructured":"Benchimol EI et al (2015) The reporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med\u00a012(10):e1001885","DOI":"10.1371\/journal.pmed.1001885"},{"issue":"3","key":"6054_CR12","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1111\/imj.14075","volume":"49","author":"L Kyi","year":"2019","unstructured":"Kyi L et al (2019) Outcomes of patients admitted to hospital medical units with back pain. Intern Med J 49(3):316\u2013322","journal-title":"Intern Med J"},{"key":"6054_CR13","doi-asserted-by":"crossref","unstructured":"Coombs DM et al (2021) Healthcare costs due to low back pain in the emergency department and inpatient setting in Sydney, Australia. Lancet Region Health West Pac\u00a07(100089)","DOI":"10.1016\/j.lanwpc.2020.100089"}],"container-title":["Clinical Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-022-06054-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10067-022-06054-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-022-06054-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T01:03:13Z","timestamp":1653008593000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10067-022-06054-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,11]]},"references-count":13,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["6054"],"URL":"https:\/\/doi.org\/10.1007\/s10067-022-06054-w","relation":{},"ISSN":["0770-3198","1434-9949"],"issn-type":[{"value":"0770-3198","type":"print"},{"value":"1434-9949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,11]]},"assertion":[{"value":"15 December 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 December 2021","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 January 2022","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2022","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}}]}}