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Management of children presenting with low back pain to emergency department

Francesco Saverio Biagiarelli1, Simone Piga2, Antonino Reale3

  • 1Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.

The American Journal of Emergency Medicine
|August 9, 2018
PubMed

Insights

Identifying red flags in children with low back pain (LBP) is crucial for diagnosing serious conditions. This study highlights key indicators and proposes a diagnostic algorithm for pediatric emergency departments.

Area of Science:

  • Pediatric Emergency Medicine
  • Musculoskeletal Disorders
  • Diagnostic Algorithms

Background:

  • Low back pain (LBP) in children presenting to emergency departments (EDs) requires careful evaluation.
  • Understanding the characteristics, causes, and healthcare utilization patterns of pediatric LBP is essential for effective management.
  • Developing a structured diagnostic approach can improve patient outcomes.

Purpose of the Study:

  • To characterize pediatric patients with LBP in an ED setting.
  • To identify the causes (etiology) and healthcare use associated with pediatric LBP.
  • To develop a diagnostic algorithm for approaching pediatric LBP cases.

Main Methods:

  • A 7-year cohort study of children presenting to the ED with LBP.
  • Classification of LBP into visceral, traumatic, and non-visceral/non-traumatic categories.
  • Analysis of high-risk factors ('red flags') for severe prognosis conditions (SPCs) within the non-visceral/non-traumatic group.

Main Results:

  • The study included 266 children (52.6% female, median age 10.5 years); 30.3% were hospitalized.
  • Serious prognosis conditions (SPCs) were identified in 18.9% of the non-traumatic/non-visceral LBP group.
  • Red flags demonstrated high sensitivity (100%) and specificity (85%) for identifying SPCs, with SPCs having earlier onset and longer symptom duration.

Conclusions:

  • Significant red flags were identified, aiding in the differentiation of serious outcomes in pediatric LBP.
  • A diagnostic algorithm was developed based on study findings and existing literature.
  • Further prospective research is needed to validate the proposed diagnostic algorithm.
Abstract

Keywords:
ChildrenEmergencyLow back painPrognosisRed flags

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