{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:10:28Z","timestamp":1791490228071,"version":"4.3.4"},"reference-count":42,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2019,5,16]]},"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>To describe the diagnoses of people who present to the emergency department (ED) with low back pain (LBP), the proportion of people with a lumbar spine condition who arrived by ambulance, received imaging, opioids and were admitted to hospital; and to explore factors associated with these four outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this retrospective study, we analysed electronic medical records for all adults presenting with LBP at three Australian EDs from January 2016 to June 2018. Outcomes included discharge diagnoses and key aspects of care (ambulance transport, lumbar spine imaging, provision of opioids, admission). We explored factors associated with these care outcomes using multilevel mixed-effects logistic regression models and reported data as ORs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 14\u2009024 presentations with a \u2018visit reason\u2019 for low back pain, of which 6393 (45.6%) had a diagnosis of a lumbar spine condition. Of these, 31.4% arrived by ambulance, 23.6% received lumbar imaging, 69.6% received opioids and 17.6% were admitted to hospital. Older patients (OR 1.79, 95%\u2009CI 1.56 to 2.04) were more likely to be imaged. Opioids were less used during working hours (OR 0.81, 95%\u2009CI 0.67 to 0.98) and in patients with non-serious LBP compared with patients with serious spinal pathology (OR 1.65, 95%\u2009CI 1.07 to 2.55). Hospital admission was more likely to occur during working hours (OR 1.74, 95%\u2009CI 1.48 to 2.05) and for those who arrived by ambulance (OR 2.98, 95%\u2009CI 2.53 to 3.51).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Many ED presentations of LBP were not due to a lumbar spine condition. Of those that were, we noted relatively high rates of lumbar imaging, opioid use and hospital admission.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2019-009383","type":"journal-article","created":{"date-parts":[[2019,6,4]],"date-time":"2019-06-04T17:35:11Z","timestamp":1559669711000},"page":"826-834","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":98,"title":["Management of low back pain in Australian emergency departments"],"prefix":"10.1136","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8534-195X","authenticated-orcid":false,"given":"Giovanni E","family":"Ferreira","sequence":"first","affiliation":[{"name":"Institute for Musculoskeletal Health, University of Sydney School of Public Health, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo C","family":"Machado","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health, University of Sydney School of Public Health, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Abdel Shaheed","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health, University of Sydney School of Public Health, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Wei Christine","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health, University of Sydney School of Public Health, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Needs","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Institute of Rheumatology and Orthopaedics, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Edwards","sequence":"additional","affiliation":[{"name":"Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rochelle","family":"Facer","sequence":"additional","affiliation":[{"name":"Emergency Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Rogan","sequence":"additional","affiliation":[{"name":"Emergency Department, Canterbury Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethan","family":"Richards","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health, University of Sydney School of Public Health, Sydney, New South Wales, Australia"},{"name":"Rheumatology Department, Institute of Rheumatology and Orthopaedics, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G","family":"Maher","sequence":"additional","affiliation":[{"name":"Institute for Musculoskeletal Health, University of Sydney School of Public Health, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,6,4]]},"reference":[{"key":"2025090410521113000_28.10.826.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31678-6"},{"issue":"Suppl 6","key":"2025090410521113000_28.10.826.2","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1007\/s00586-017-5432-9","article-title":"The global spine care initiative: a summary of the global burden of low back and neck pain studies","volume":"27","author":"Hurwitz","year":"2018","journal-title":"Eur Spine J"},{"key":"2025090410521113000_28.10.826.3","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.111271"},{"key":"2025090410521113000_28.10.826.4","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1016\/S0140-6736(18)30489-6","article-title":"Prevention and treatment of low back pain: evidence, challenges, and promising directions","volume":"391","author":"Foster","year":"2018","journal-title":"Lancet"},{"key":"2025090410521113000_28.10.826.5","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181d952a5"},{"key":"2025090410521113000_28.10.826.6","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.annemergmed.2011.09.012","article-title":"One-week and 3-month outcomes after an emergency department visit for undifferentiated musculoskeletal low back pain","volume":"59","author":"Friedman","year":"2012","journal-title":"Ann Emerg Med"},{"key":"2025090410521113000_28.10.826.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2011.09.002"},{"key":"2025090410521113000_28.10.826.8","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/1742-6723.12602","article-title":"Imaging for patients presenting to an emergency department with back pain: impact on patient pathway","volume":"28","author":"McCaughey","year":"2016","journal-title":"Emerg Med Australas"},{"key":"2025090410521113000_28.10.826.9","doi-asserted-by":"crossref","unstructured":"Lovegrove MT , Jelinek GA , Gibson NP , et al . Analysis of 22,655 presentations with back pain to Perth emergency departments over five years. Int J Emerg Med 2011;4.doi:10.1186\/1865-1380-4-59","DOI":"10.1186\/1865-1380-4-59"},{"key":"2025090410521113000_28.10.826.10","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2013-203120"},{"key":"2025090410521113000_28.10.826.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-016845","article-title":"Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study","volume":"7","author":"Eastwood","year":"2017","journal-title":"BMJ Open"},{"key":"2025090410521113000_28.10.826.12","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1111\/imj.14075","article-title":"Outcomes of patients admitted to hospital medical units with back pain","volume":"49","author":"Kyi","year":"2019","journal-title":"Intern Med J"},{"key":"2025090410521113000_28.10.826.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"2025090410521113000_28.10.826.14","unstructured":"Health NSW . A picture of health: Sydney local health district health profile 2015."},{"key":"2025090410521113000_28.10.826.15","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.5694\/j.1326-5377.2011.tb02934.x","article-title":"Developing a national emergency department data reference set based on SNOMED CT","volume":"194","author":"Hansen","year":"2011","journal-title":"Med J Aust"},{"key":"2025090410521113000_28.10.826.16","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-019052","article-title":"Implementation of an evidence-based model of care for low back pain in emergency departments: protocol for the Sydney Health Partners Emergency Department (SHaPED) trial","volume":"8","author":"Machado","year":"2018","journal-title":"BMJ Open"},{"key":"2025090410521113000_28.10.826.17","doi-asserted-by":"crossref","first-page":"94","DOI":"10.5847\/wjem.j.1920-8642.2015.02.002","article-title":"The reliability of the Australasian triage scale: a meta-analysis","volume":"6","author":"Ebrahimi","year":"2015","journal-title":"World J Emerg Med"},{"key":"2025090410521113000_28.10.826.18","unstructured":"Australian Bureau of Statistics . Socio-economic indexes for areas (SEIFA) 2016, 2018. Available: https:\/\/www.abs.gov.au\/ausstats\/abs@.nsf\/mf\/2033.0.55.001"},{"key":"2025090410521113000_28.10.826.19","unstructured":"World Health Organization . WHO collaborating centre for drug statistics methodology, guidelines for ATC classification and DDD assignment 2014 2013."},{"key":"2025090410521113000_28.10.826.20","doi-asserted-by":"crossref","first-page":"3257","DOI":"10.1002\/sim.7336","article-title":"Intermediate and advanced topics in multilevel logistic regression analysis","volume":"36","author":"Austin","year":"2017","journal-title":"Stat Med"},{"key":"2025090410521113000_28.10.826.21","unstructured":"National Institute for Health and Care Excellence . Low back pain and sciatica in over 16S: assessment and management 2016."},{"key":"2025090410521113000_28.10.826.22","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1007\/s00586-017-5178-4","article-title":"Worsening trends in analgesics recommended for spinal pain in primary care","volume":"27","author":"Mathieson","year":"2018","journal-title":"Eur Spine J"},{"key":"2025090410521113000_28.10.826.23","doi-asserted-by":"crossref","first-page":"686","DOI":"10.3171\/2015.7.SPINE14133","article-title":"Emergency room resource utilization by patients with low-back pain","volume":"24","author":"Drazin","year":"2016","journal-title":"J Neurosurg Spine"},{"key":"2025090410521113000_28.10.826.24","doi-asserted-by":"crossref","unstructured":"Nunn ML , Hayden JA , Magee K . Current management practices for patients presenting with low back pain to a large emergency department in Canada. BMC Musculoskelet Disord 2017;18.doi:10.1186\/s12891-017-1452-1","DOI":"10.1186\/s12891-017-1452-1"},{"key":"2025090410521113000_28.10.826.25","unstructured":"American College of Emergency Physicians . Choosing wisely: five things physicians and patients should question, 2013. Available: http:\/\/www.choosingwisely.org\/societies\/american-college-of-emergency-physicians\/ [Accessed 10 Oct 2018]."},{"key":"2025090410521113000_28.10.826.26","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2002.121523"},{"key":"2025090410521113000_28.10.826.27","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2367"},{"key":"2025090410521113000_28.10.826.28","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1001\/jamainternmed.2016.1251","article-title":"Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis","volume":"176","author":"Abdel Shaheed","year":"2016","journal-title":"JAMA Intern Med"},{"key":"2025090410521113000_28.10.826.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-011278","article-title":"Opal: a randomised, placebo-controlled trial of opioid analgesia for the reduction of pain severity in people with acute spinal pain. Trial protocol","volume":"6","author":"Lin","year":"2016","journal-title":"BMJ Open"},{"key":"2025090410521113000_28.10.826.30","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1001\/jama.2017.16190","article-title":"Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial","volume":"318","author":"Chang","year":"2017","journal-title":"JAMA"},{"key":"2025090410521113000_28.10.826.31","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0899"},{"key":"2025090410521113000_28.10.826.32","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.annemergmed.2016.10.002","article-title":"Diazepam is no better than placebo when added to naproxen for acute low back pain","volume":"70","author":"Friedman","year":"2017","journal-title":"Ann Emerg Med"},{"key":"2025090410521113000_28.10.826.33","doi-asserted-by":"crossref","unstructured":"Sun EC , Dixit A , Humphreys K , et al . Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ 2017;356.doi:10.1136\/bmj.j760","DOI":"10.1136\/bmj.j760"},{"key":"2025090410521113000_28.10.826.34","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1056\/NEJMsa1610524","article-title":"Opioid-prescribing patterns of emergency physicians and risk of long-term use","volume":"376","author":"Barnett","year":"2017","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025090410521113000_28.10.826.35","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12328"},{"key":"2025090410521113000_28.10.826.36","unstructured":"Australian Institute of Health and Welfare (AIHW) . Opioid harm in Australia and comparisons between Australia and Canada. Canberra: AIHW, 2018."},{"key":"2025090410521113000_28.10.826.37","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.jemermed.2015.06.014","article-title":"Impact of an opioid prescribing guideline in the acute care setting","volume":"50","author":"del Portal","year":"2016","journal-title":"J Emerg Med"},{"key":"2025090410521113000_28.10.826.38","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1016\/j.ajem.2013.06.002","article-title":"Multidisciplinary intervention decreases the use of opioid medication discharge packs from 2 urban EDS","volume":"31","author":"Gugelmann","year":"2013","journal-title":"Am J Emerg Med"},{"key":"2025090410521113000_28.10.826.39","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.annemergmed.2009.12.011","article-title":"A statewide prescription monitoring program affects emergency department prescribing behaviors","volume":"56","author":"Baehren","year":"2010","journal-title":"Ann Emerg Med"},{"key":"2025090410521113000_28.10.826.40","doi-asserted-by":"publisher","DOI":"10.1136\/emj.15.4.212"},{"key":"2025090410521113000_28.10.826.41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jemermed.2013.08.140","article-title":"Risk factors for serious underlying pathology in adult emergency department nontraumatic low back pain patients","volume":"47","author":"Thiruganasambandamoorthy","year":"2014","journal-title":"J Emerg Med"},{"key":"2025090410521113000_28.10.826.42","unstructured":"Australasian College of Emergency Medicine . Triage quick reference guide: assessment of pain, 2013. Available: http:\/\/www.health.gov.au\/internet\/publications\/publishing.nsf\/Content\/triageqrg~triageqrg-pain [Accessed 10 Oct 2018]."}],"container-title":["BMJ Quality &amp; Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjqs-2019-009383","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T17:52:23Z","timestamp":1757008343000},"score":1,"resource":{"primary":{"URL":"https:\/\/qualitysafety.bmj.com\/lookup\/doi\/10.1136\/bmjqs-2019-009383"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,4]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,9,19]]},"published-print":{"date-parts":[[2019,10]]}},"alternative-id":["10.1136\/bmjqs-2019-009383"],"URL":"https:\/\/doi.org\/10.1136\/bmjqs-2019-009383","relation":{},"ISSN":["2044-5415","2044-5423"],"issn-type":[{"value":"2044-5415","type":"print"},{"value":"2044-5423","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,4]]}}}