Emergency room resource utilization by patients with low-back pain

Area of Science:

• Health Services Research
• Epidemiology
• Health Economics

Background:

• Low-back pain (LBP) is a common reason for hospital admission.
• Understanding admission pathways, such as through the emergency room (ER), is crucial for resource allocation and patient outcomes.
• Factors influencing ER admission for LBP patients require investigation.

Purpose of the Study:

• To identify factors associated with emergency room (ER) admission for patients with a primary diagnosis of low-back pain (LBP).
• To evaluate the impact of ER admission on mortality, discharge disposition, and hospital length of stay.
• To analyze trends in ER utilization for LBP over time.

Main Methods:

• Retrospective analysis of the Nationwide Inpatient Sample (NIS) database from 1998-2007.
• Inclusion of patients with a primary diagnosis of low-back pain (LBP).
• Univariate and multivariate analyses to assess factors associated with ER admission and patient outcomes.

Main Results:

• Over 183,000 LBP patients were analyzed; 65% were admitted via the ER, with a rising trend (54% in 1998 to 71% in 2005).
• Uninsured (OR 2.1) and African American (OR 1.5) patients were more likely to be admitted through the ER.
• Higher income patients (OR 1.3) and those with more comorbidities also showed increased ER admission likelihood.
• ER admission did not affect mortality but increased the odds of non-routine discharge (OR 1.39).

Conclusions:

• A majority of LBP hospital admissions occur via the ER, with increasing annual utilization.
• ER admission for LBP is associated with higher rates of non-routine discharge.
• Socioeconomic factors, including insurance status and income, alongside race and comorbidities, significantly influence ER admission patterns for LBP patients.
• Findings suggest potential disparities in healthcare access and utilization impacting LBP patient outcomes.