{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T02:52:17Z","timestamp":1774925537862,"version":"3.50.1"},"reference-count":83,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,12,12]],"date-time":"2017-12-12T00:00:00Z","timestamp":1513036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100002076","name":"Emergency Medicine Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002076","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Low back pain (LBP) is a common presentation to the ED, and a frequent cause of disability globally. The ED management is often associated with high rates of imaging, misuse and overuse of pharmacology and subsequent financial implications. Given this, improved quality of care for patients with LBP in ED is essential. This rapid review investigated best practice for the assessment and management of LBP in the ED. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2015. Primary studies, systematic reviews and guidelines were considered for inclusion. English\u2010language articles published in the past 10 years that addressed acute LBP assessment, management or prognosis in the ED or acute setting were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 1538 articles, of which 38 were included in the review (<jats:italic>n<\/jats:italic> = 8 primary articles, <jats:italic>n<\/jats:italic> = 13 systematic reviews and <jats:italic>n<\/jats:italic> = 17 guidelines). This rapid review provides clinicians managing LBP in the ED a summary of the best available evidence to risk stratify and enhance the quality of care, optimising patient outcomes. Consistent evidence was found to support the use of \u2018red flags\u2019 to screen for serious pathologies, diagnostic tests being reserved for use only in the presence of red flags, the judicious prescribing of opioids, identification of psychosocial risk factors as predictors of poorer outcome and promotion of early return to work and function.<\/jats:p>","DOI":"10.1111\/1742-6723.12907","type":"journal-article","created":{"date-parts":[[2017,12,12]],"date-time":"2017-12-12T23:38:49Z","timestamp":1513121929000},"page":"18-35","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Review article: Best practice management of low back pain in the emergency department (part 1 of the musculoskeletal injuries rapid review series)"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8765-2295","authenticated-orcid":false,"given":"Kirsten","family":"Strudwick","sequence":"first","affiliation":[{"name":"Emergency Department Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service  Brisbane Queensland Australia"},{"name":"Physiotherapy Department Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service  Brisbane Queensland Australia"},{"name":"School of Health and Rehabilitation Sciences The University of Queensland  Brisbane Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"McPhee","sequence":"additional","affiliation":[{"name":"Physiotherapy Department Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service  Brisbane Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Bell","sequence":"additional","affiliation":[{"name":"Emergency and Trauma Centre Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service  Brisbane Queensland Australia"},{"name":"Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melinda","family":"Martin\u2010Khan","sequence":"additional","affiliation":[{"name":"Centre for Health Services Research, Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trevor","family":"Russell","sequence":"additional","affiliation":[{"name":"School of Health and Rehabilitation Sciences The University of Queensland  Brisbane Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,12,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204428"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmpt.2004.02.002"},{"key":"e_1_2_8_4_1","unstructured":"Australian Institute of Health and Welfare. Musculoskeletal Fact Sheet: Back Problems. Arthritis series no. 21. Cat. no. PHE 185. Canberra: Australian Institute of Health and Welfare 2015"},{"key":"e_1_2_8_5_1","unstructured":"Australian Institute of Health and Welfare. How Much Is Spent on Back Problems? 2015. [Cited 30 Nov 2016.] Available from URL:http:\/\/www.aihw.gov.au\/back\u2010problems\/expenditure\/2016"},{"key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1865-1380-4-59","article-title":"Analysis of 22,655 presentations with back pain to Perth emergency departments over five years","volume":"4","author":"Lovegrove MT","year":"2011","journal-title":"Int. J. Emerg. Med."},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.12602"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.BRS.0000105527.13866.0F"},{"key":"e_1_2_8_9_1","first-page":"183","article-title":"Low\u2010back pain at the emergency department: still not being managed?","volume":"12","author":"Rizzardo A","year":"2016","journal-title":"Ther. Clin. Risk Manag."},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2001.91141.x"},{"key":"e_1_2_8_11_1","volume-title":"Evidence\u2010Based Management of Acute Musculoskeletal Pain \u2013 A Guide for Clinicians","author":"Australian Acute Musculoskeletal Pain Guidelines Group","year":"2004"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006205-200604000-00005"},{"key":"e_1_2_8_13_1","volume-title":"Four Hour Rule Program Progress and Issues Review","author":"Stokes B","year":"2011"},{"key":"e_1_2_8_14_1","volume-title":"Emergency Department Outcome Indicators: Consultation Report (Attachment 1)","author":"Hospitals Principal Committee","year":"2014"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2005.0230.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.507"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200112010-00017"},{"key":"e_1_2_8_18_1","unstructured":"NPS MedicineWise. Choosing Wisely Australia 2016. [Cited 5 Sep 2016.] Available from URL:http:\/\/www.choosingwisely.org.au\/home"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2015.06.018"},{"key":"e_1_2_8_20_1","volume-title":"Cancer Pain Relief: With a Guide to Opioid Availability","author":"World Health Organization","year":"1996"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.8992"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181d952a5"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7283.400"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2015.10.015"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30970-9"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2010.099226"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-006-1071-2"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.111271"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199902000-00006"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a171"},{"key":"e_1_2_8_31_1","first-page":"U2536","article-title":"Exploring general practitioner identification and management of psychosocial Yellow Flags in acute low back pain","volume":"120","author":"Crawford C","year":"2007","journal-title":"NZ Med. J."},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.12906"},{"key":"e_1_2_8_33_1","unstructured":"National Health and Medical Research Council. NHMRC Additional Levels of Evidence and Grades for Recommendations for Developers of Guidelines. 2009. [Cited 23 Feb 2015.] Available from URL:https:\/\/www.nhmrc.gov.au\/_files_nhmrc\/file\/guidelines\/developers\/nhmrc_levels_grades_evidence_120423.pdf"},{"key":"e_1_2_8_34_1","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1136\/emermed-2013-203490","article-title":"Does a single dose of intravenous dexamethasone reduce symptoms in emergency department patients with low back pain and RAdiculopathy (SEBRA)? A double\u2010blind randomised controlled trial","volume":"32","author":"Balakrishnamoorthy R","year":"2015","journal-title":"Emerg. Med. J."},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000038"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2011.01105.x"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2012-201670"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2010.00735.x"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2006.038182"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0004-9514(08)70003-5"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2013.08.140"},{"key":"e_1_2_8_42_1","first-page":"1","article-title":"An evidence\u2010based approach to the evaluation and treatment of low back pain in the emergency department","volume":"15","author":"Borczuk P","year":"2013","journal-title":"Emerg. Med. Pract."},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2013.11.007"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f7095"},{"key":"e_1_2_8_45_1","first-page":"CD008686","article-title":"Red flags to screen for malignancy in patients with low\u2010back pain","author":"Henschke N","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.04.013"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2014.01.026"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.141183"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2014.02.029"},{"key":"e_1_2_8_50_1","first-page":"1","article-title":"An updated overview of clinical guidelines for the management of non\u2010specific low back pain in primary care","author":"Koes BW","year":"2010","journal-title":"Eur. Spine J."},{"key":"e_1_2_8_51_1","doi-asserted-by":"crossref","DOI":"10.3310\/hta15390","article-title":"The clinical effectiveness and cost\u2010effectiveness of management strategies for sciatica: systematic review and economic model","volume":"15","author":"Lewis R","year":"2011","journal-title":"Health Technol. Assess."},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S50243"},{"key":"e_1_2_8_53_1","first-page":"CD008643","article-title":"Red flags to screen for vertebral fracture in patients presenting with low\u2010back pain","author":"Williams CM","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_8_54_1","unstructured":"ACEM and the Royal College of Pathologists of Australasia. Guideline on Pathology Testing in the Emergency Department. 2013. [Cited 4 Mar 2015.] Available from URL:http:\/\/www.acem.org.au\/standards\u2010publications\/policies\u2010guidelines.aspx"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmpt.2007.11.003"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.06.013"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-7-200710020-00006"},{"key":"e_1_2_8_58_1","volume-title":"Guideline Summary: Low Back Pain Medical Treatment Guidelines","author":"Colorado Division of Workers' Compensation","year":"2014"},{"key":"e_1_2_8_59_1","volume-title":"ACR Appropriateness Criteria: Suspected Spine Trauma","author":"Daffner R","year":"2012"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2012.42.4.A1"},{"key":"e_1_2_8_61_1","unstructured":"American College of Occupational and Environmental Medicine (ACOEM). Low back disorders. 2011. [Cited 8 Apr 2015.]Available from URL:http:\/\/guidelines.gov\/content.aspx?f=rss&id=38438"},{"key":"e_1_2_8_62_1","volume-title":"Educational Modules for Appropriate Imaging Referrals: Point of Care Tools for the Emergency Department","author":"Goergen S","year":"2014"},{"key":"e_1_2_8_63_1","volume-title":"Work\u2010Related Acute Cauda Equina Syndrome (CES) Diagnosis and Treatment","author":"Washington State Department of Labor and Industries","year":"2014"},{"key":"e_1_2_8_64_1","volume-title":"Management of Acute Low Back Pain in Adults","author":"Michigan Quality Improvement Consortium","year":"2014"},{"key":"e_1_2_8_65_1","volume-title":"Emergency Care Acute Pain Management Manual","author":"National Institute of Clinical Studies","year":"2011"},{"key":"e_1_2_8_66_1","volume-title":"Guideline for the Evidence\u2010Informed Primary Care Management of Low Back Pain","author":"Toward Optimized Practice","year":"2011"},{"key":"e_1_2_8_67_1","unstructured":"Canadian Association of Radiologists. CAR Diagnostic Imaging Referral Guidelines. 2012. [Cited 12 May 2015.] Available from URL:http:\/\/www.car.ca\/uploads\/standards%20guidelines\/car\u2010referralguidelines\u2010c\u2010en_20120918.pdf"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31827559b8"},{"key":"e_1_2_8_69_1","doi-asserted-by":"publisher","DOI":"10.1071\/AH08634"},{"key":"e_1_2_8_70_1","unstructured":"Work Loss Data Institute. Guideline Summary: Low Back \u2013 Lumbar & Thoracic (Acute & Chronic).2013. [Cited 8 Apr 2015.] Available from URL:http:\/\/guideline.gov\/content.aspx?f=rss&id=47586"},{"key":"e_1_2_8_71_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199702150-00015"},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A0999"},{"key":"e_1_2_8_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60172-0"},{"key":"e_1_2_8_74_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2011.01265.x"},{"key":"e_1_2_8_75_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12446"},{"key":"e_1_2_8_76_1","first-page":"1","article-title":"Variation in opioid prescribing patterns between ED providers","author":"Smulowitz PB","year":"2016","journal-title":"Intern. Emerg. Med."},{"key":"e_1_2_8_77_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2003.10.043"},{"key":"e_1_2_8_78_1","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20100224"},{"key":"e_1_2_8_79_1","first-page":"12","article-title":"Preventing disabling chronic pain by engaging psychologists in the acute phase","volume":"38","author":"Nicholas MK","year":"2016","journal-title":"InPsych"},{"key":"e_1_2_8_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60937-9"},{"key":"e_1_2_8_81_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181f8f775"},{"key":"e_1_2_8_82_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja13.10508"},{"key":"e_1_2_8_83_1","first-page":"182","article-title":"Returning to work after an injury","volume":"42","author":"Fenner P","year":"2013","journal-title":"Aust. Fam. Physician"},{"key":"e_1_2_8_84_1","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2013-101571"}],"container-title":["Emergency Medicine Australasia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1742-6723.12907","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1742-6723.12907","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T07:44:11Z","timestamp":1695541451000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1742-6723.12907"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,12]]},"references-count":83,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,2]]}},"alternative-id":["10.1111\/1742-6723.12907"],"URL":"https:\/\/doi.org\/10.1111\/1742-6723.12907","archive":["Portico"],"relation":{},"ISSN":["1742-6731","1742-6723"],"issn-type":[{"value":"1742-6731","type":"print"},{"value":"1742-6723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,12]]},"assertion":[{"value":"2016-10-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-03-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-12-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}