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Back pain in children who present to the emergency department
S M Selbst1, J M Lavelle, S K Soyupak
1Division of Emergency Medicine, Children's Hospital of Philadelphia, USA.
Insights
Pediatric back pain is uncommon in emergency departments, often stemming from trauma or infections. While usually not serious, it frequently disrupts children's daily activities.
Area of Science:
- Pediatrics
- Emergency Medicine
- Epidemiology
Background:
- Back pain is a frequent complaint in adults, but its presentation and causes in children visiting emergency departments are less understood.
- Identifying the epidemiology and etiology of pediatric back pain is crucial for appropriate diagnosis and management.
Purpose of the Study:
- To determine the causes and epidemiology of back pain in children presenting to an urban pediatric emergency department.
- To analyze demographic data, pain characteristics, and diagnostic outcomes for pediatric back pain cases.
Main Methods:
- A prospective study evaluated children with back pain over one year using a uniform questionnaire.
- Data collected included patient demographics, pain onset, impact on daily activities, and final diagnoses.
- Diagnostic imaging, such as radiographs, was reviewed for utility.
Main Results:
- 225 children presented with back pain; the mean age was 11.9 years, with 60% being female.
- Common causes included direct trauma (25%), muscle strain (24%), sickle cell crises (13%), and idiopathic (13%).
- Back pain significantly impacted daily activities, causing missed school/work in 52% and sleep disruption in 47%.
Conclusions:
- Pediatric back pain is an uncommon emergency department presentation, predominantly musculoskeletal, linked to trauma or acute illness.
- While rarely serious, pediatric back pain significantly affects children's daily lives, necessitating thorough evaluation.
- Radiographs were of limited diagnostic value; hospital admission was infrequent, mainly for sickle cell crises.
Abstract:
The purpose of this study was to identify the causes and epidemiology of back pain in children who present to the emergency department. All children who presented to an urban pediatric emergency department (ED) during a 1-year period with the chief complaint of back pain were examined and evaluated with a uniform questionnaire. This was completed at the time of the ED visit in 48%, and within 48 hours in 52%. During a 1-year period, 225 children with a complaint of back pain were evaluated. The mean age was 11.9 +/- 4 years and 60% were female. Onset was acute (< or = 2 days) in 59%, and chronic (> or = 4 weeks) in only 11.6%. Pain awakened children from sleep in 47%, and caused 52% to miss school or work. The most common diagnoses were direct trauma (25%), muscle strain (24%), sickle cell crises (13%), idiopathic (13%), urinary tract infection (5%), and viral syndrome (4%). Radiographs of the back were rarely helpful. About 5% required hospital admission; one half of these were attributed to sickle cell crises. We conclude that back pain is an uncommon reason for children to present to an emergency department. When present, pediatric back pain is most often musculoskeletal, associated with an acute infectious illness or a traumatic event. Although the etiology is rarely serious, back pain often affects the daily activities of symptomatic children.
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