Profiling the patients visiting the emergency room for musculoskeletal complaints: characteristics and outcomes
Mattia Bellan1,2, Rossella Molinari3, Luigi Castello4,5
1Department of Translational Medicine, Università del Piemonte Orientale UPO, via Solaroli 17, Novara, NO, 28100, Italy. bellanmattia@yahoo.it.
Insights
Emergency room (ER) physicians often see non-traumatic musculoskeletal complaints. While true emergencies are rare, many patients require urgent specialist referral, not primary care.
Area of Science:
- Emergency Medicine
- Orthopedics
- Musculoskeletal Disorders
Background:
- Non-traumatic musculoskeletal complaints are a frequent reason for emergency room (ER) visits.
- Physicians in the ER manage these conditions, but the acuity varies significantly.
- Differentiating between true emergencies, urgent referrals, and primary care needs is crucial for efficient patient management.
Purpose of the Study:
- To quantify the proportion of non-traumatic musculoskeletal complaints presenting to the ER that represent true emergencies.
- To determine the number of patients requiring prompt specialist referral (urgencies).
- To identify conditions suitable for primary care management.
Main Methods:
- Retrospective analysis of clinical records for patients visiting the ER over one year.
- Exclusion of pediatric and obstetrics/gynecology cases.
- Classification of non-traumatic musculoskeletal complaints into true emergencies, urgencies, and non-urgent conditions.
Main Results:
- Out of 54,915 ER patients, 1652 (3.0%) presented with non-traumatic musculoskeletal symptoms.
- Back pain (57.1%) had few true emergencies (0.6%) but a notable proportion of urgencies (11.1%).
- Peripheral joint complaints (42.9%) had very few true emergencies (0.3%) but a high rate of urgencies (29.7%).
Conclusions:
- True emergencies are uncommon among non-traumatic musculoskeletal complaints in the ER.
- A significant percentage of these patients require urgent specialist evaluation and management.
- ER physicians must be adept at identifying conditions needing prompt referral to avoid delayed care.
Abstract:
Non-traumatic musculoskeletal complaints are often dealt with by emergency room (ER) physicians. We aimed to quantify how many patients with such complaints have conditions requiring immediate recognition and treatment, versus specialist referral, versus primary care. We retrieved the clinical records of all the patients admitted to the ER department of our hospital along 1 year. Pediatric (age <14 years) and obstetrics/gynecology cases were excluded. Data from all patients visiting the ER for non-traumatic musculoskeletal complaints were classified as follows: true emergencies (i.e., conditions associated with high morbidity/mortality risk), urgencies (i.e., conditions requiring prompt referral to a specialist), and non-urgent conditions (to be dealt with in primary care). Out of 54,915 patients evaluated in the ER of our hospital, 1652 patients complained of non-traumatic musculoskeletal symptoms (3.0 %): Back pain accounted for 944/1652 ER visits (57.1 %), including 6 emergencies (0.6 %) and 105 urgent conditions (11.1 %). Among the remaining 708 patients (42.9 %) who presented with complaints concerning a peripheral joint, true emergencies were 2/708 (0.3 %) while 210/708 were urgent conditions (29.7 %). Although patients who present to ER physicians with musculoskeletal complaints have rarely true emergencies, many of them are in need of urgent treatment and prompt specialist referral.
