One-Week and 3-Month Outcomes After an Emergency Department Visit for Undifferentiated Musculoskeletal Low Back Pain
One-Week and 3-Month Outcomes After an Emergency Department Visit for Undifferentiated Musculoskeletal Low Back Pain
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DOI：
10.1016/j.annemergmed.2011.09.012
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发表时间：
2012-02-01
影响因子：
6.2
通讯作者：
Gallagher, E. John
中科院分区：
文献类型：
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作者：
Friedman, Benjamin W.;O'Mahony, Sean;Gallagher, E. John
研究目的：每年有近300万名患有未分化肌肉骨骼下腰痛的患者到美国急诊科就诊。对这一群体的短期和长期结果知之甚少。我们试图描述出院后1周和3个月出现未分化肌肉骨骼下腰痛的ED患者的疼痛和功能结果。方法：我们采用前瞻性观察性描述性队列设计，纳入ED主治医生将下腰痛归类为肌肉骨骼疼痛的主诉的ED患者。我们将下腰痛定义为起源于肩胛尖和上臀部之间的背部后部的疼痛，排除了前一个月内发生的任何创伤性背部损伤的患者。我们访问了急诊室的患者，然后在ED出院后1周和3个月通过电话随访，使用脚本化的封闭式问题数据收集工具。我们的主要结果是可归因于下腰痛的功能受限，用有效的量表进行评估。次要结果包括每次电话随访前24小时内疼痛和止痛药的使用。结果：从2009年7月开始的9个月期间，我们接触了894名患者，其中556人入选。我们在1周和3个月时分别获得了97%和92%的随访率。ED出院一周后，70%(95%可信区间[CI]66%至74%)患者报告与背痛相关的功能损害，59%(95%可信区间55%至63%)报告中度或重度下腰痛，69%(95%可信区间65%至73%)报告在过去24小时内使用止痛药。ED出院3个月后，48%(95%可信区间44%至52%)患者报告功能障碍，42%(95%可信区间38%至46%)报告中度或重度疼痛，46%(95%可信区间44%至50%)报告在过去24小时内使用止痛药。结论：在出现未分化肌肉骨骼下腰痛的ED患者中，存在大量短期和长期的发病率和持续使用止痛药。访问数/每百万人：Reach for[Ann Emerg2012；59：128-133。]
Study objective: Nearly 3 million patients present to US emergency departments (EDs) annually with undifferentiated musculoskeletal low back pain. Little is known about short- and longer-term outcomes in this group. We seek to describe the pain and functional outcomes 1 week and 3 months after discharge in a sample of ED patients presenting with undifferentiated musculoskeletal low back pain.Methods: We used a prospective observational descriptive cohort design, enrolling ED patients with a chief complaint of low back pain classified as musculoskeletal in origin by the ED attending physician. We defined low back pain as pain originating in the posterior back between the tips of the scapulae and upper buttocks and excluded any patient with a traumatic back injury occurring within the previous month. We interviewed patients in the ED and then by telephone follow-up 1 week and 3 months after ED discharge, using a scripted closed-question data collection instrument. Our primary outcome was functional limitation attributable to low back pain assessed with a validated scale. Secondary outcomes included pain and analgesic use during the 24 hours before each follow-up telephone call.Results: During a 9-month period beginning in July 2009, we approached 894 patients, of whom 556 were enrolled. We obtained follow-up on 97% of our sample at 1 week and 92% at 3 months. One week after ED discharge, 70% (95% confidence interval [CI] 66% to 74%) of patients reported back pain related functional impairment, 59% (95% CI 55% to 63%) reported moderate or severe low back pain, and 69% (95% CI 65% to 73%) reported analgesic use within the previous 24 hours. Three months after ED discharge, 48% (95% CI 44% to 52%) of patients reported functional impairment, 42% (95% CI 38% to 46%) reported moderate or severe pain, and 46% (95% CI 44% to 50%) reported analgesic use within the previous 24 hours.Conclusion: There is substantial short- and longer-term morbidity and ongoing analgesic use among patients who present to an ED with undifferentiated musculoskeletal low back pain. [Ann Emerg Med. 2012;59: 128-133.]